Skin Biopsy vs Excision

rmness

Contributor
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12
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Fargo
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There is debate in my office between whether biopsies or excisions and or shave removals should be billed for certain procedures. I was trained that you have to go by what was documented in the note as well as what the intention of the procedure was. An example is say a provider documents they perform a tangential biopsy by shave technique of a lesion on the trunk which was then submitted for pathologic examination. In the process of the biopsy the entire 0.5cm lesion of the trunk ends up being removed. In my opinion this should be coded as 11102 as the intention and documentation was for a biopsy. Other opinions are that a 11300 should be coded as the lesion was removed and intention should not factor into what is coded. Which is correct?
 

kseebeck

Networker
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25
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Winter Springs, FL
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I like use the M.I.S.S. guidance when reviewing documentation for coding: Method - Intent - Site - Size.
Intention of the procedure is very important.

Per a AAPC Webinar I recently attend:
Biopsy vs Shave Removal
“…procedure to obtain tissue solely for diagnostic, histopathologic examination…” CPT Codebook​
Contrast with shave removal or excision where the intent is to remove (usually for therapeutic reasons) and obtain tissue for diagnostic, histopathologic examination.​
“It is the responsibility of the physician or qualified health care professional performing the procedure to clearly indicate the purpose of the procedure.” – CPT Codebook​
 

rmness

Contributor
Messages
12
Location
Fargo
Best answers
0
I like use the M.I.S.S. guidance when reviewing documentation for coding: Method - Intent - Site - Size.
Intention of the procedure is very important.

Per a AAPC Webinar I recently attend:
Biopsy vs Shave Removal
“…procedure to obtain tissue solely for diagnostic, histopathologic examination…” CPT Codebook​
Contrast with shave removal or excision where the intent is to remove (usually for therapeutic reasons) and obtain tissue for diagnostic, histopathologic examination.​
“It is the responsibility of the physician or qualified health care professional performing the procedure to clearly indicate the purpose of the procedure.” – CPT Codebook​
Thank you for your response!
 
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