How To Use CPT Code 21920

CPT code 21920 describes the biopsy of superficial soft tissue in the back or flank area. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 21920?

CPT 21920 is used to describe the biopsy of superficial soft tissue in the back or flank area. This procedure involves the removal of a small sample of suspicious tissue, such as a lump just beneath the skin, for further analysis. The purpose of the biopsy is to determine the presence of abnormal cells, particularly cancerous cells.

2. Official Description

The official description of CPT code 21920 is: ‘Biopsy, soft tissue of back or flank superficial.’

3. Procedure

During the biopsy procedure, the patient is appropriately prepped and anesthetized. The healthcare provider makes an incision over the suspicious area on the patient’s skin. Using microdissection, the provider carefully excises a sample of the superficial soft tissue. The excised tissue specimen is then sent for analysis to determine if there are any abnormal cells present, especially cancerous cells. After the biopsy, the provider irrigates the wound area and closes the incision with sutures.

4. Qualifying circumstances

CPT 21920 is performed when there is a need to obtain a sample of superficial soft tissue for analysis. This may be necessary when there is a suspicious lump or growth in the back or flank area. The procedure is typically performed by a healthcare provider who is trained and qualified to perform biopsies. It is important to note that the biopsy is performed on superficial soft tissue, which refers to the tissue that supports and surrounds bones, organs, and other structures.

5. When to use CPT code 21920

CPT code 21920 should be used when a biopsy of superficial soft tissue in the back or flank area is performed. It is important to ensure that the biopsy is specifically targeting the superficial soft tissue and not deeper structures. If the biopsy is performed on deeper tissue or involves a different anatomical location, a different CPT code should be used.

6. Documentation requirements

To support a claim for CPT code 21920, the healthcare provider must document the following information:

• Patient’s medical history and reason for the biopsy
• Details of the procedure, including the location of the biopsy and the size of the incision
• Description of the tissue sample obtained
• Documentation of any complications or adverse events
• Pathology report or results of the analysis of the tissue sample
• Signature of the healthcare provider performing the biopsy

7. Billing guidelines

When billing for CPT code 21920, it is important to ensure that the procedure performed matches the description of the code. The biopsy should specifically target superficial soft tissue in the back or flank area. It is also important to follow any specific billing guidelines provided by the payer or insurance company. It is recommended to review the documentation requirements and guidelines provided by the payer to ensure accurate and appropriate billing.

8. Historical information

CPT code 21920 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Similar codes to CPT 21920

There are several similar codes to CPT code 21920 that are used for different biopsy procedures. These include:

• CPT 21921: Biopsy, soft tissue of back or flank deep
• CPT 21922: Biopsy, soft tissue of thigh or knee superficial
• CPT 21923: Biopsy, soft tissue of thigh or knee deep
• CPT 21924: Biopsy, soft tissue of lower leg or ankle superficial
• CPT 21925: Biopsy, soft tissue of lower leg or ankle deep

9. Examples

1. A dermatologist performing a biopsy on a suspicious lump on a patient’s back.
2. An orthopedic surgeon performing a biopsy on a superficial soft tissue mass in the flank area.
3. A plastic surgeon performing a biopsy on a suspicious lesion on a patient’s back.
4. An oncologist performing a biopsy on a tumor in the flank area to determine the presence of cancerous cells.
5. A general surgeon performing a biopsy on a superficial soft tissue mass in the back for further analysis.
6. A pathologist analyzing a tissue sample obtained from a biopsy of superficial soft tissue in the flank area.
7. A radiologist performing a guided biopsy on a suspicious lesion in the back using imaging techniques.
8. A primary care physician referring a patient to a specialist for a biopsy of superficial soft tissue in the back.
9. A nurse assisting a healthcare provider during a biopsy procedure on superficial soft tissue in the flank area.
10. A patient undergoing a biopsy of superficial soft tissue in the back to determine the cause of a persistent lump.