Question regarding the procedure code 11100.

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According to the cpt book on procedure code 11100, this is the obtaining of tissue for pathology. Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; single lesion. It does not list how this biopsy is done. In the AAPC coder under lay terms of procedure code 11100, She uses a scalpel, skin punch, or other instrument for excision of the sample tissue. So, this procedure is used for a punch biopsy? Correct?...We are having a discussion in the office regarding this procedure and that this cannot be used as a punch biopsy!
I could use some feedback on this..
Thanks,
Terri D., CPC
 

Chelle-Lynn

True Blue
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An example of 11100 would that the physician removes a sample of a defect in the skin, subcutaneous tissue or mucous membrane for pathologic examination. Only one sample is removed, and the resulting defect may be closed simply or may not require closure.

1. The use of a biopsy procedure code indicates that the procedure to obtain tissue for pathologic examination was performed independently, or was unrelated or distinct from other procedures/services provided at that time.

2. Such biopsies are not considered components of other procedures when performed on different lesions or different sites on the same date, and are to be reported separately.

3. If the entire lesion is removed with a margin of normal tissue, report an excision instead of a biopsy. Report any layered or complex closure in addition to the biopsy code.

4. The procedure note should indicate the presence of a mass, lump, skin lesion, skin or membrane defect, or an area of suspicion.

It does not specify the type of removal, so as long as the removal meets the criteria above, the process of removal is open ended.
 
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