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Thread: Biopsies Coding

  1. #1

    Default Biopsies Coding

    AAPC: Back to School
    we have a provider who wants to use CPT codes 40490, 69100, 11755, 54100, 56605 and 67800 instead of the Biopsies code 11100 and 11101. This provider is a dermatolgist.
    Also we use 1995 guidelines in aduiting a charts notes and this provider wnats us to use 1997. Can anyone help me on what the differents are?


  2. #2


    The physician should use the other codes when biopsy is done for those specific sites. Reimbursment is usualy higher. And it is more specific. The 95 guidelines make it harder for a dermatology or specialty physician because they have to review all systems, ect.. The 97 guidelines are more specialty specific. Hope this helps.

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default Auditing

    Every reputable auditor I know of uses BOTH 1995 and 1997 guidelines and gives the provider whichever comes out higher.

    If documentation supports the use of the codes from the various OTHER sections of surgical coding (vs integumentary), then those are the correct CPT codes to use.

    Forgive me, but, YOU are auditing and you don't know this?

    F Tessa Bartels, CPC, CEMC

  4. #4
    Join Date
    Apr 2007
    Columbia, MO


    I do not see why there is an issue with a dermatologist doing biopsies of these areas. I agree with Tessa on this. Who better than a derm doc to biopsy a lip, an ear, a penis?

    Debra A. Mitchell, MSPH, CPC-H

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