Q&A: CPT coding and reporting guidelines for skin biopsies

May 10, 2019
Medicare Web

Q: The American Medical Association (AMA) added three new CPT codes for skin biopsies, effective January 1. What are the new biopsy codes and CPT guidelines for reporting them?

A: In 2019, the AMA deleted CPT codes 11100 (biopsy of skin, subcutaneous tissue and mucous membrane including simple closure, unless otherwise listed; single lesion) and add-on code 11101 (…; each additional lesion) and replaced these codes with six new biopsy codes. These codes are defined by the method of obtaining the biopsy and can be broken down into three categories: tangential, punch, and incisional skin biopsies.

During a tangential skin biopsy, the provider removes thin slices of a lesion using a blade. This type of biopsy may be documented as a shave, a scoop, a saucerization, or a curette. The following CPT codes are used to report a tangential biopsy:

  • 11102, tangential biopsy of the skin; single lesion
  • Add-on code 11103, …; each separate or additional lesion

A punch biopsy is a diagnostic test involving the removal of a small tube-shaped piece of skin using a sharp cutting tool. A simple closure of the wound is included with this procedure and should therefore not be separately reported. The following 2019 CPT codes are used to report a punch biopsy:

  • 11104, punch biopsy of the skin, including simple closure, when performed; single lesion
  • Add-on code 11105, …; each separate or additional lesion

An incisional skin biopsy involves the removal of a small wedge of tissue from a lesion to identify the composition and type of cells within the lesion. The following CPT codes are used to report an incisional skin biopsy: 

  • 11106, incisional biopsy of the skin (e.g., wedge), including simple closure, when performed; single lesion
  • Add-on code 11107, …; each separate or additional lesion

Per the 2019 CPT guidelines, when multiple biopsy techniques are performed during the same encounter, only one primary biopsy code may be reported. This code should be for the most complex type of biopsy performed.

Coders can use the following skin biopsy hierarchy, outlined below, to help them select the appropriate CPT code for the primary procedure:

Incisional biopsies, which sit at the top of the hierarchy, are the most complex type of skin biopsy, followed by punch biopsies and tangential biopsies.

If the provider performs additional biopsies, these procedures should be reported using applicable CPT add-on codes. For example, suppose a patient presents with three lesions including one lesion on his neck and two on his right leg. A surgeon removes the lesion on his neck via a skin shave, one lesion on his leg using a punch technique, and the second leg lesion on his leg using an incisional technique.

The coder should report CPT code 11106 for the primary procedure, as this describes an incisional biopsy, and add-on codes 11105 and 11103 for the punch and tangential biopsies, respectively.

Editor’s note: Lisa Rae Roper, MS, MHA, CCS-P, PCS, CPC, CPC-I, FAHIMA, healthcare consultant in Missoula, Montana, answered this question during the DecisionHealth webinar, Understand the 2019 Biopsy Codes for Correct Reporting and Reimbursement.

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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