How To Use CPT Code 11104

CPT 11104 refers to a punch biopsy of skin, including simple closure when performed, for a single lesion. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 11104 procedures.

1. What is CPT 11104?

CPT 11104 is a medical code used to describe a punch biopsy of the skin, which involves the removal of a small, circular sample of skin tissue for examination. This code includes simple closure when performed and is applicable for a single lesion. The procedure is commonly used to diagnose skin conditions and diseases, such as skin cancer, by analyzing the biopsy sample in a pathology lab.

2. 11104 CPT code description

The official description of CPT code 11104 is: “Punch biopsy of skin (including simple closure, when performed); single lesion.”

3. Procedure

  1. The patient is prepared and anesthetized, typically with local anesthesia.
  2. The provider stretches the skin with the lesion perpendicular to resting skin lines to change its shape from round to oval and reduce the possibility of a dog-ear defect during suturing.
  3. The provider selects a punch size based on the size of the lesion; typical sizes vary from 3 to 5 mm but can be larger.
  4. The provider uses their thumb and middle finger to support and rotate the punch and their index finger to stabilize and exert pressure on it.
  5. The provider rotates the punch as they push it into the skin until they feel the resistance give way, which indicates that they have reached the subcutaneous tissue.
  6. The biopsy specimen is removed, and a suture may be placed to close the tissue or allow the wound to heal by secondary intention if the area has good vascularization (blood flow).
  7. The specimen is sent to the pathology lab for analysis.

4. Qualifying circumstances

Patients eligible to receive CPT code 11104 services are those with suspicious skin lesions that require a punch biopsy for diagnostic purposes. This may include lesions that are atypical in appearance, have changed over time, or are symptomatic (e.g., itching, bleeding, or painful). The punch biopsy procedure is typically performed by a dermatologist or other qualified healthcare provider.

5. When to use CPT code 11104

It is appropriate to bill the 11104 CPT code when a punch biopsy of a single skin lesion is performed for diagnostic purposes. This code should be used for each separate lesion that requires a punch biopsy. If additional procedures are performed on the same lesion, such as incisional or tangential biopsies, separate codes should be used to describe those services.

6. Documentation requirements

To support a claim for CPT 11104, the following information should be documented in the patient’s medical record:

  • Indication for the punch biopsy (e.g., suspicious lesion, atypical appearance, change in size or color, symptomatic lesion)
  • Size and location of the lesion
  • Size of the punch used for the biopsy
  • Details of the procedure, including anesthesia, stretching of the skin, rotation and insertion of the punch, removal of the specimen, and closure method (if applicable)
  • Pathology report with the analysis of the biopsy specimen

7. Billing guidelines

When billing for CPT code 11104, it is essential to follow the appropriate guidelines and rules. Some tips and codes that apply to CPT code 11104 include:

  • Report CPT 11105 for each separate or additional lesion that requires a punch biopsy, in addition to CPT 11104 for the primary procedure.
  • For an incisional biopsy of a skin lesion, report CPT 11106 for the initial lesion and +11107 for each additional lesion.
  • For a tangential biopsy (e.g., shave, scoop, saucerize, curette) using a blade or curette, report CPT 11102 for the initial lesion and +11103 for each separate additional lesion.

8. Historical information

CPT 11104 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates to the code since its addition.

9. Similar codes to CPT 11104

Five similar codes to CPT 11104 and how they differentiate from CPT 11104 are:

  1. CPT 11105: This code is used for each separate or additional lesion that requires a punch biopsy, in addition to CPT 11104 for the primary procedure.
  2. CPT 11106: This code is used for an incisional biopsy of a skin lesion for the initial lesion.
  3. +11107: This add-on code is used for each additional lesion that requires an incisional biopsy, in conjunction with CPT 11106.
  4. CPT 11102: This code is used for a tangential biopsy (e.g., shave, scoop, saucerize, curette) using a blade or curette for the initial lesion.
  5. +11103: This add-on code is used for each separate additional lesion that requires a tangential biopsy, in conjunction with CPT 11102.

10. Examples

Here are 10 detailed examples of CPT code 11104 procedures:

  1. A patient presents with a suspicious mole on their upper arm. The dermatologist performs a punch biopsy using a 4 mm punch and sends the specimen to the pathology lab for analysis.
  2. A patient has a lesion on their back that has changed in size and color. The provider performs a punch biopsy using a 5 mm punch and sutures the wound closed.
  3. A patient has a painful lesion on their leg. The provider performs a punch biopsy using a 3 mm punch and allows the wound to heal by secondary intention.
  4. A patient has a lesion on their chest with an atypical appearance. The provider performs a punch biopsy using a 4 mm punch and sutures the wound closed.
  5. A patient has a lesion on their scalp that has been itching and bleeding. The provider performs a punch biopsy using a 5 mm punch and sends the specimen to the pathology lab for analysis.
  6. A patient has a lesion on their face that has changed in size and shape. The provider performs a punch biopsy using a 3 mm punch and sutures the wound closed.
  7. A patient has a lesion on their abdomen with an irregular border. The provider performs a punch biopsy using a 4 mm punch and allows the wound to heal by secondary intention.
  8. A patient has a lesion on their thigh that has been symptomatic. The provider performs a punch biopsy using a 5 mm punch and sutures the wound closed.
  9. A patient has a lesion on their neck with an atypical appearance. The provider performs a punch biopsy using a 3 mm punch and sends the specimen to the pathology lab for analysis.
  10. A patient has a lesion on their forearm that has changed in color and size. The provider performs a punch biopsy using a 4 mm punch and allows the wound to heal by secondary intention.

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