Wiki New biopsy codes vs CCI

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THK

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The CCIs state that 11102 and 11104 cannot under any circumstance be billed together which I understand would be true for the same lesion but our notes clearly document one lesion treated w/ shave and another completely separate (diagnostically and anatomically) treated with punch biopsy. Am I misunderstanding the new codes?
 
Where are you seeing that CCI states that these cannot be billed together? I don't see any NCCI edits between these two codes in the new tables released by CMS and no reference to this in the revised policy manual for 2019.
 
I was able to find it on the NCCI tables V25 eff 1/1/19 after an email response from findacode. I don't know why I didn't see it the first time (click thumbnail to see)

11104.jpg

According to the CPT guidelines its legit:

[FONT=&quot]If a punch biopsy is performed, report [/FONT]11104[FONT=&quot] in combination with a tangential ([/FONT]11103[FONT=&quot]), or punch ([/FONT]11105[FONT=open sans, Arial, sans-serif]), for the additional biopsy procedures.
Click to expand...
[/FONT]

[FONT=open sans, Arial, sans-serif]So if a Tangential biopsy is done with a more complicated biopsy. The primary code will be the more complicated biopsy (in this case 11104) and the add on code for the tangential would be used for the second lesion (11103)

There is quite a hierarchy involved in these new codes[/FONT]
 
Hello! If your provider performs one tangential biopsy via shave technique and one punch biopsy, you would code the skin biopsy with the highest RVU first. You would not code multiple primary skin biopsy codes from range 11102-11107.
For this scenario, you would code:
CPT 11104 (primary) x1
CPT 11103 (+add on) x1

**Second scenario for clarity**

Provider performs one incisional biopsy, one punch biopsy, and one tangential.

11106 (primary) x1
11105 (+add on) x1
11103 (+add on) x1

I hope this helps you and your dermatology providers. Please feel free to get in touch with my directly and I’d be more than happy to help your group!
Robert Meza
Linkedin: http://linkedin.com/in/dermbillingexpert
 
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Wouldn't the example above ( Provider performs one incisional biopsy, one punch biopsy, and one tangential biopsy) be coded as follows?

11106 (primary) x1
11105 (+add-on) x1
11103 (+add on) x1

thanks,
 
Per guidelines, "When different techniques are used to perform biopsies of two or more separate and distinct lesions, report the appropriate primary biopsy code and add on code if applicable for each biopsy performed." Report only one primary biopsy code regardless of how many different techniques are used. I got this information off the coding companion for Plastics/Dermatology 2019. From what I understand the new biopsy codes may be mixed and matched to report multiple biopsies. I hope this helps!
 
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