You would need to look at the provider's intent. If it was to remove the entire lesion using the punch, then it would be considered excision. If the intent was to biopsy, take a sample or piece, then it would be a biopsy code. I think the information that "btadlock1" was looking for is in the CPT® Assistant, October 2004, Skin Biopsy Coding Guidelines
. There is more information available in the article as well. I recommend you review that article as well if you have access to the CPT® Assistant References.
The biopsy guidelines from the CPT 2004 (page 50 of the Professional Edition) read as follows:
During certain surgical procedures in the integumentary system, such as excision, destruction, or shave removals, the removed tissue is often submitted for pathologic examination. The obtaining of tissue for pathology during the course of these procedures is a routine component of such procedures. This obtaining of tissue is not considered a separate biopsy procedure and is not separately reported. The use of a biopsy procedure code (eg, 11100, 11101) 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. 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.
To understand the guidelines, it is helpful to know the key distinctions between biopsy and other skin procedures. A skin biopsy procedure differs in several ways from other integumentary system procedures, such as excision, destruction, or shave removals. First, the intent of a biopsy is different and the procedure itself can vary somewhat from the other procedures. A skin biopsy may be performed on a lesion or on certain areas of skin to diagnose certain skin diseases or systemic conditions. The intent of a biopsy is to remove a portion of skin, suspect lesion, or entire lesion so that it can be examined pathologically. For example, a punch biopsy may be performed to obtain a portion of tissue from a skin lesion. The wound may be closed with a suture. The removed tissue is the biopsy specimen, which is sent for pathological examination. Code 11100 may be reported for such an instance.
The intent of other integumentary system procedures that involve removal of tissue is different. Generally, they are performed for the purpose of removing an entire lesion. The following example regarding excision of a skin lesion should be contrasted against the prior discussion about biopsy procedures. The intent of an excision procedure is to remove the entire lesion along with a margin of normal tissue around it. A nevus is entirely removed with the use of a punch and the wound is closed with one suture. The removed nevus, with its margin of normal tissue, is sent for pathological examination. Depending on the final diagnosis in the pathology report, the appropriate code from either 11400-11446 (benign) or 11600-11646 (malignant) may be reported. Obtaining or removing the tissue in this procedure is part of the procedure itself, ie, removing the lesion in this manner is the procedure. It is not considered a separate biopsy procedure; therefore, a biopsy code is not separately reported.”
A. Farmer, CPC
Originally Posted by btadlock1
Originally Posted by btadlock1
Originally Posted by mhstrauss