How To Use CPT Code 54100

CPT 54100 describes the procedure for a biopsy of the penis, specifically for the collection of a sample from a superficial skin lesion. This article will cover the official description, procedure details, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 54100?

CPT 54100 is used to describe the biopsy procedure performed on the penis to collect a sample from a superficial skin lesion. This code is specifically for diagnostic purposes and involves the removal of a small portion of the lesion using a scalpel or punch needle. If necessary, the provider may close the defect with a suture.

2. Official Description

The official description of CPT code 54100 is: ‘Biopsy of penis; (separate procedure).’ This code is used when the provider performs a biopsy of a superficial skin lesion on the penis for diagnostic purposes.

3. Procedure

1. The patient is appropriately prepped and anesthetized for the procedure.
2. The provider uses a scalpel or punch needle to remove a small portion of the superficial skin lesion on the penis.
3. If necessary, the provider closes the defect with a suture.

4. Qualifying circumstances

CPT 54100 is used for the biopsy of superficial penile lesions only. It is important to note that this code is specifically for diagnostic purposes and should not be used for biopsies of deep skin lesions on the penis. If the biopsy involves deep structures, CPT code 54105 should be used instead.

5. When to use CPT code 54100

CPT code 54100 should be used when the provider performs a biopsy of a superficial skin lesion on the penis for diagnostic purposes. It is important to ensure that the biopsy is limited to superficial lesions and not deep structures. If the biopsy involves deep structures, CPT code 54105 should be used instead.

6. Documentation requirements

To support a claim for CPT 54100, the provider must document the following information:

• The need for the biopsy and the specific superficial skin lesion being biopsied
• The method used for the biopsy (scalpel or punch needle)
• If applicable, the closure of the defect with a suture

7. Billing guidelines

When billing for CPT 54100, it is important to ensure that the procedure performed matches the description of the code. This code should only be used for the biopsy of superficial penile lesions. If the biopsy involves deep structures, CPT code 54105 should be used instead. It is also important to follow any additional guidelines provided by the payer or coding guidelines.

8. Historical information

CPT code 54100 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. Examples

1. A provider performs a biopsy of a superficial skin lesion on the penis to determine the nature of the lesion.
2. During a routine examination, a provider notices a suspicious superficial skin lesion on the penis and decides to perform a biopsy for further evaluation.
3. A patient presents with a visible superficial skin lesion on the penis, and the provider performs a biopsy to obtain a sample for diagnostic purposes.
4. After discussing the risks and benefits with the patient, a provider performs a biopsy of a superficial skin lesion on the penis to rule out any potential malignancy.
5. A provider performs a biopsy of a superficial skin lesion on the penis as part of a comprehensive evaluation of the patient’s condition.
6. During a follow-up visit, a provider decides to perform a biopsy of a superficial skin lesion on the penis to gather more information about the lesion.
7. A patient presents with multiple superficial skin lesions on the penis, and the provider performs biopsies of each lesion to determine their nature.
8. After reviewing the patient’s medical history and conducting a physical examination, a provider decides to perform a biopsy of a superficial skin lesion on the penis to aid in diagnosis.
9. A provider performs a biopsy of a superficial skin lesion on the penis to assess the presence of any abnormal cells or tissues.
10. During a procedure, a provider notices a suspicious superficial skin lesion on the penis and decides to perform a biopsy for further investigation.