If the provider does a punch biopsy but removes the entire lesion with the punch would this be coded as an excision because he removed the entire lesion or would it still be a punch biopsy 11100 since that was the manner in which it was removed?
Good question...)
My initial instinct was to say 'biopsy', since you mentioned the punch biopsy - I could've sworn that the CPT descriptions, or guidelines, mentioned that by name, but I can't find it anywhere, now.
In fact, neither the biopsy or excision codes really mention surgical method(s), except to say that 'shaving of lesions', has its own section of codes. The guidelines under excision state:
"Excision is defined as full-thickness (through the dermis) removal of a lesion, including margins, and includes simple closure when performed...Code selection is determined by measuring the greatest clinical diameter of the apparent lesion plus that margin required for complete excision..." - No approach/method is mentioned.
The biopsy guidelines make it pretty clear, that an excision includes a biopsy, but a biopsy doesn't necessarily include an excision. My interpretation of the rules, is that the biopsy codes are used, when only a sample is being taken to send to pathology, and excision codes are for when the whole lesion is removed (and, when needed, sent to pathology).
If the whole lesion was taken, and the provider documented the size w/margins correctly, I'd say go with the excision code, for 3 reasons:
1. The method of removal ('punch biopsy') doesn't appear to be mentioned anywhere in the CPT guidelines or descriptions, that I could find. (If it's in there, someone please tell me where to find it, because now it's gonna bug me!
2. Regardless of what method was used, it accomplished the same thing as a scalpel excision (assuming it was documented properly, of course) - the whole lesion is gone, and is being sent to pathology.
3. The provider would be short-changing themselves on reimbursement, since biopsy codes are paid at a much lower rate (which is probably because they have the potential to lead to an excision, later on - if my "biopsy = sample" theory is correct.) If he accomplished the work of an excision, then he should be reimbursed, accordingly.
That's just my opinion, though - I'd be interested to see what others think about this one.
My initial instinct was to say 'biopsy', since you mentioned the punch biopsy - I could've sworn that the CPT descriptions, or guidelines, mentioned that by name, but I can't find it anywhere, now.
In fact, neither the biopsy or excision codes really mention surgical method(s), except to say that 'shaving of lesions', has its own section of codes. The guidelines under excision state:
"Excision is defined as full-thickness (through the dermis) removal of a lesion, including margins, and includes simple closure when performed...Code selection is determined by measuring the greatest clinical diameter of the apparent lesion plus that margin required for complete excision..." - No approach/method is mentioned.
The biopsy guidelines make it pretty clear, that an excision includes a biopsy, but a biopsy doesn't necessarily include an excision. My interpretation of the rules, is that the biopsy codes are used, when only a sample is being taken to send to pathology, and excision codes are for when the whole lesion is removed (and, when needed, sent to pathology).
If the whole lesion was taken, and the provider documented the size w/margins correctly, I'd say go with the excision code, for 3 reasons:
1. The method of removal ('punch biopsy') doesn't appear to be mentioned anywhere in the CPT guidelines or descriptions, that I could find. (If it's in there, someone please tell me where to find it, because now it's gonna bug me!
2. Regardless of what method was used, it accomplished the same thing as a scalpel excision (assuming it was documented properly, of course) - the whole lesion is gone, and is being sent to pathology.
3. The provider would be short-changing themselves on reimbursement, since biopsy codes are paid at a much lower rate (which is probably because they have the potential to lead to an excision, later on - if my "biopsy = sample" theory is correct.) If he accomplished the work of an excision, then he should be reimbursed, accordingly.
That's just my opinion, though - I'd be interested to see what others think about this one.
11100 is just a biopsy - by any method (punch biopsies are usually coded here). The purpose of 11100 is only to take a sample of the lesion, for pathologic examination.
11300-11313 are shave removals. They include a "biopsy", but the purpose is to remove the whole lesion - not just a piece of it. Shave removals are used for lesions that don't extend beyond the dermis. (you might think of them as 'Shallow' lesions). You don't have to send the lesion for pathologic examination, but if you do, it's included in the CPT code.
Excisions (11400-11646), differ from shave removals, in that they are the full-thickness removal of lesions (eg, through the subcutaneous tissue...for removal of 'Deep' lesions). These take margins into account in their diameter-measurements, and include a simple repair (sutures, chemical or electrocauterization of wounds, etc.) They are also classified by 'benign' or 'malignant' - neither shave removals or biopsies include a 'malignancy' aspect (if you already know it's malignant, there's no need to send it to pathology - you'd just cut the whole thing out...)
Make sense?