What You Should Know About The 2019 Updated Biopsy Codes

Prior to the new CPT codes for 2019, we would report biopsies with CPT code 11100 for the first lesion and 11101 for each additional lesion biopsied regardless of the method of removal. The Centers for Medicare and Medicaid Services (CMS) has deleted CPT 11100 and 11101. The new CPT codes are described below, based on the method clinicians use to remove the tissue sent for pathology examination.

When performing a biopsy, the intent of the procedure is to obtain tissue solely for diagnostic histopathologic examination. The doctor performing the procedure should clearly indicate the purpose of the procedure in the documentation. For therapeutic removal of epidermal or dermal lesion, please review the CPT manual for the appropriate therapeutic codes based on the method of removal.

Tangential biopsy. One can perform a tangential biopsy, often referred to as a shave biopsy, via saucerization or utilize a curette to obtain the specimen. Often physicians perform this biopsy with an obliquely angled sharp blade, such as a flexible biopsy blade, or a bone curette to remove a sample of epidermal tissue with or without portions of underlying dermis. This does not require a suture closure.

•    CPT 11102. Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette); single lesion.

•    CPT 11103. Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette); each separate/additional lesion. List this code in addition to the primary procedure code for each additional lesion specimen removed and submitted for examination.

Punch biopsy. This requires a punch tool to remove a full-thickness cylindrical sample of skin. A punch biopsy may or may not require a suture closure.

•    CPT 11104. Punch biopsy of skin (includes simple closure, if performed); single lesion.

•    CPT 11105. Punch biopsy of skin (includes simple closure, if performed); each separate additional lesion(s). List the code for the primary lesion in addition to the added lesions removed and submitted.

Incisional biopsy. This requires the use of a surgical blade to remove a full-thickness sample of tissue with a vertical incision or wedge, which cuts both epidermis and deep to the dermis as well as the subcutaneous space. Closure is usually required on incisional biopsies. However, simple closure is not billed or paid separately. This is included as part of the procedure.

•    CPT 11106. Incisional biopsy of skin, example a wedge or ellipse (includes simple closure, when performed); single lesion.

•    CPT 11107. Incisional biopsy of skin, example wedge or ellipse (including simple closure, when performed); each separate lesion(s) is listed in addition to the primary lesion code.

When performing different biopsy techniques to sample separate lesions, list code(s) for each type of biopsy technique you use, counting all of the lesions you remove and submit for pathology examination.

Don’t forget to update your charge tickets or superbills if your practice is not completely electronic yet. This way, you are capturing all of the services you are performing and your billers and coders can do their jobs accurately so you are being paid for services you perform. Of course, we must always make sure our documentation supports the claims we are submitting.

This has become such a hot topic, both at the hospital and in private practices in the past two years. In my practice, the billing staff cannot bill or send claims until my notes are complete, which requires me to lock or sign off on my notes in 24 to 48 hours as our billing policy requires that the billing staff complete initial claim submission within 48 hours of the date of visit. This ensures that we can correct any errors or omissions I have made in documentation in a timely fashion, that we can submit the claims in a timely fashion, and that our cash flow remains at a healthy rate so the practice can meet its financial obligations.