Skin biopsy is one of the most common procedures that dermatologists perform on a daily basis. The coding changes unveiled for dermatology include a set of six new biopsy codes (three primary codes, each with an add-on code). The new skin biopsy codes are CPT 11102-11107. Dermatology practices and medical coding outsourcing companies need to be ready to apply these coding updates and revisions in 2019.
The two existing primary CPT codes for biopsy of the skin are:
11100 Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed.
11101, …for each additional lesion biopsied after the first lesion on the same date of service.
These codes are used to report an independent procedure to obtain tissue for pathologic analysis. They can be used to report all methods of removal: removal by scissors, shaving with a blade or specialized instrument to any level including the subcutaneous fat, removal using a punch, and excision down to the subcutaneous fat using a scalpel.
However, the American Academy of Dermatology notes that surveys revealed dermatologists are using codes 11100 and 11101 in a distinct and inconsistent manner. In fact, these primary and add-on code for biopsy of the skin, have been under scrutiny by the Centers for Medicare and Medicaid Services (CMS) for high utilization.
Accordingly, the American Medical Association developed the set of six new CPT codes to allow for greater specificity about the technique and depth of the biopsy performed. The six new codes, which include primary codes for tangential, punch, and incisional skin biopsies, plus three add-on codes for each technique, are as follows:
11102 Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette) single lesion
+ 11103 each separate/additional lesion (List separately in addition to code for primary procedure)
11104 Punch biopsy of skin (including simple closure, when performed) single lesion
+11105 each separate/additional lesion (List separately in addition to code for primary procedure
11106 incisional biopsy of skin (e.g., wedge) (including simple closure, when performed) single lesion
+11107 each separate/additional lesion (List separately in addition to code for primary procedure
- Tangential biopsy (11102 and 11103)comprises removal via shave, scoop, saucerization or curette. Performed with a sharp blade such as a flexible biopsy blade, obliquely oriented scalpel or curette, it removes a sample of epidermal tissues with or without portions of the underlying dermis.
- Punch biopsy (11104 and 11105) involves using an instrument to remove a full thickness cylindrical sample of the skin. The area of the punch biopsy is often marked prior to the procedure. Punch biopsy includes simple closure.
- Incisional biopsy (11106 and 11107) involves using a sharp blade to remove the tissue sample. The full thickness of the dermis is involved the procedure which may include removing a sample of subcutaneous fat as well as simple closure..
A recent ICD 10 Monitor article offers additional tips on reporting skin biopsy:
- When more than one biopsy is performed on the same date, only one primary biopsy code should be reported.
- When a biopsy is performed on different lesions or different sites on the same day, each biopsy may be reported separately as they are not considered components of other procedures.
- When more than one biopsy is performed using the same technique, the relevant primary biopsy code should be reported for the first biopsy and the add-on code should be reported for each additional lesion.
- If multiple biopsies are performed using different methods, one primary code should be reported and an-add code should be used based on the biopsy method for each additional biopsy on the same date.
- When the entire lesion is excised, excision codes 11400-11646 should be reported based on whether the lesion was benign or malignant.
Documentation should include the method of removal and anatomic site. The American Academy of Dermatologist will publish all necessary information to educate providers about the new codes and how to use them starting January 1, 2019. The support of an experienced dermatology medical coding service provider can be invaluable for coding skin procedures. Expert coders have the knowledge necessary to assign the correct codes. This includes familiarity with procedures such as shaving, excisions and biopsies, knowing how to distinguish simple, intermediate, and complex repairs, and how to deal with sizing terms such as length, depth, width, and circumference.