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cpt 11100

  1. #1
    Default cpt 11100
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    if 2 separate punch biopsies are done on the same lesion, can you code for the additional punch biopsy? any help would be greatly appreciated.

    thank you.

  2. Default bundled or separate biopsy
    this was from the Nov 2010 coding edge. Hope this helps!

    “If the biopsy is performed on the
    same lesion on which a more extensive
    procedure is performed, it is separately
    reportable only if the biopsy is utilized
    for immediate pathologic diagnosis
    prior to the more extensive procedure,
    and the decision to proceed with the
    more extensive procedure is based on
    the diagnosis established by the pathologic
    In other words, if the results of the biopsy
    prompt the physician to perform a more
    extensive procedure, both the more extensive
    procedure and the biopsy may be reported.
    As an example, consider a patient with
    a suspicious lesion on the forearm: If the
    physician excises the lesion and sends it
    to pathology, we know that the biopsy is
    not reported separately because, as NCCI
    explains, “If a biopsy is performed and
    submitted for pathologic evaluation that
    will be completed after the more extensive
    procedure is performed, the biopsy is not
    separately reportable with the more extensive
    Suppose, however, that the physician sends a
    portion of the suspicious lesion for examination,
    and pathology confirms a malignancy.
    The physician proceeds to excise the entire
    lesion. In this case, because the biopsy led to
    the decision to perform the more extensive
    procedure, both the excision (e.g., 11603
    Excision, malignant lesion including margins,
    trunk, arms, or legs; excised diameter 2.1 to
    3.0 cm) and the biopsy (11100 Biopsy of skin,
    subcutaneous tissue and/or mucous membrane
    (including simple closure), unless otherwise listed;
    single lesion) may be reported separately.
    NCCI instructs you to append modifier 58
    Staged or related procedure or service by the same
    physician during the postoperative period to the
    excision code (11603), “to indicate that the
    biopsy and the more extensive procedure

  3. #3
    Columbia, MO
    Quote Originally Posted by PMiklavcic View Post
    if 2 separate punch biopsies are done on the same lesion, can you code for the additional punch biopsy? any help would be greatly appreciated.

    thank you.
    You may only report one biopsy of the same lesion. You could report both only if performed on separate lesions. The 59 modifier - separate site, separate organ, separate incision. If it is the same lesion you have not met the requirement to use the 59 modifier.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    This helps tremendously............thank you both so much!!

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