20160930 - Save Up to 43% on CPC Training | Learn More

AAPC - August DL Sale: 50% OFF
Results 1 to 4 of 4

Thread: cpt 11100

  1. #1

    Default cpt 11100

    AAPC: CPC Promo
    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. #2

    Default bundled or separate biopsy

    Hi-
    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
    examination.”
    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
    procedure.”
    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
    Join Date
    Apr 2007
    Location
    Columbia, MO
    Posts
    12,082

    Default

    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

    Default

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

Similar Threads

  1. 67810 vs 11100
    By JSTEPHENS in forum Dermatology
    Replies: 1
    Last Post: 04-04-2014, 10:14 AM
  2. 11100
    By wilccm in forum Dermatology
    Replies: 2
    Last Post: 02-18-2013, 08:46 AM
  3. Billing CPT 11100 verses to 19100
    By danette1206 in forum Hematology/Oncology
    Replies: 0
    Last Post: 10-21-2010, 10:23 AM
  4. Cpt 11100
    By NESmith in forum Dermatology
    Replies: 1
    Last Post: 04-19-2010, 12:13 PM
  5. 11100
    By Maryst in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 04-22-2009, 08:00 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.