CPT Codes For Punch Biopsy (2022) – Descriptions, Guidelines, Reimbursement, Modifiers & Examples
CPT code for punch biopsy description, coding guidelines and more are included in this article. Skin lesions can be benign at first but develop into malignant lesions with time. The benefit of detecting early skin cancer is that therapy may begin, and biopsies can cure the disease.
However, before treatment can begin, a skin biopsy is required to establish the type of lesion. Therefore, when reporting skin biopsies, you must include the type of biopsy conducted and the anatomic location. Also, remember that excision codes contain biopsy codes; thus, you should not report codes separately.
CPT Code For Punch Biopsy Description
If the provider suspects skin cancer, a section of skin may be excised and sent to a laboratory for examination under a microscope, known as a skin biopsy. A pathologist examines a sample of tissue obtained from the patient’s lesion or tumor to provide a diagnosis.
He may need to remove the entire tumor to cure basal or squamous cell skin cancer in certain circumstances, or the patient may require different therapy.
Types of Skin Biopsies
The type of skin biopsy conducted is decided by the suspected type of skin cancer, the location of the disease on the body, its size, and other considerations.
Because that usually leaves a scar following a biopsy, it may be crucial if it is in a visible region. A pathologist uses a small needle to provide a local anesthetic in the area.
A tangential biopsy is also known as a shave biopsy. This method comprises scooping or curette removal. A thin surgical blade extracts a sample of epidermal tissue, which may or may not contain dermal tissue.
Therefore, this is a partial-thickness biopsy. In addition, because the pathologist only samples a section of the skin or mucous membrane, this is a partial-thickness biopsy. Therefore, it does not require a stitched closure since it does not encompass the entire thickness of the dermis.
A punch biopsy includes the excision of a full-thickness cylindrical skin sample using a small round instrument like a cookie cutter. A full-thickness biopsy penetrates the dermis or lamina propria and the subcutaneous or submucosal region. The pathologist may or may not stitch the site’s edges together.
An incisional biopsy utilizes a sharp blade to extract a full-thickness sample through a wedge or vertical incision. Pathologists frequently stitch the Wound edges together. Then, they can use an excisional biopsy to physically remove the whole tumor and some normal tissue surrounding it.
After performing a skin biopsy, they transfer it to a lab, where a pathologist examines it under a microscope. Finally, they frequently submit the samples to a dermatopathologist with specialized skills in analyzing skin samples.
The sooner the findings are returned with a confirmed diagnosis, the sooner therapy may begin.
CPT Code For Punch Biopsy Billing & Coding Guidelines
Healthcare providers use CPT codes 11102, 11103, 11104, 11105, 11106, and 11107 to bill for skin biopsy procedures. When conducting a biopsy operation separately, they use these codes to acquire tissue for diagnostic histopathologic analysis or perform concurrently with unrelated or different services.
These biopsy codes are as follows:
CPT 11102 narrates a tangential biopsy of skin for a single lesion (e.g., shaving, scooping, curette).
CPT 11103 describes skin tangential biopsy (e.g., shave, scoop, curette) for each distinct/additional lesion (List separately for additional biopsy to code for primary procedure).
CPT 11104 narrates a punch biopsy of skin (with easy closure if done) for a single lesion.
CPT 11105 narrates the punch biopsy of skin (including simple closure if performed) for each separate/additional lesion (list individually for additional biopsy to the primary operation code).
According to CPT, when one biopsy method is utilized on many lesions on the same patient during the same contact, the base code is recorded, followed by the add-on code for each subsequent biopsy done.
Two tangential biopsies, for example, are recorded as CPT 11102 x 1 and CPT 11103 x 1.
Three punch biopsies are billable as CPT 11104 x 1 and CPT 11105 x 2.
Four incisional biopsies are billable as CPT 11106 x 1 and CPT 11107 x 3.
Even if numerous distinct procedures are employed, only one base code (CPT 11102, CPT 11104, or CPT 11106) should be issued when doing more than one biopsy technique on a patient during the same session. (Note: The code determines the primary code with the highest value).
For instance, CPT 11106 has more excellent value than CPT 11104. Therefore, they should record additional biopsies with the appropriate add-on codes (CPT 11103, CPT 11105, or CPT 11107).
If the physician does a punch biopsy on one lesion and a tangential biopsy on another, the coder may outline CPT 11104 x 1 and CPT 11103 x 1. CPT code 11104 is the primary code for punch biopsy, whereas 11103 is an add-on code for tangential biopsy. Because CPT 11104 has more value, the coder must report it first.
The diagnostic center may record punch biopsy codes if the procedure is to gather tissue samples for diagnostic assessment. Biopsies done on different locations or lesions on the same day of service may be reported independently.
When employing multiple procedures on the same lesion during the same session, the physician should outline only one primary biopsy code. In addition to CPT 11102, CPT 11104, and CPT 11106, report CPT 11103, CPT 11105, or CPT 11107 based on biopsy procedures.
There is no need to report separately for any local anesthesia. Report 99000 for handling or transportation if delivering the tissue to an outside laboratory. Use CPT 68100 for conjunctival biopsy and CPT 67810 for eyelid biopsy. Use CPT 11440 – CPT 11446 or CPT 11640 – CPT 11646 for lesion excision.
Note the primary/main code with the highest RVU and attach the add-on code unique to the additional biopsies performed if executing several biopsies using different procedures.
CPT Code For Punch Biopsy Modifiers
The following are modifiers commonly used:
Use Modifier 22 when the biopsy procedure takes longer than regular procedural services.
Use Modifier 51 when performing multiple biopsies at a time.
Use Modifier 52 when partially reducing the biopsy methodology due to some circumstances.
When stopping a surgical or diagnostic biopsy procedure after it has begun due to unforeseen circumstances, use Modifier 53.
When performing the procedure during a global period, use Modifier 58. It may be staged or related to an operation or service performed by the same provider or another health care provider during the postoperative period.
Use Modifier 59 when performing other distinct procedural services other than E/M.
Use Modifier 78 when a patient has an unplanned return to the operating room by the same healthcare provider or other qualified healthcare professional following an initial procedure for a related service during the postoperative period.
Use Modifier 79 when a physician performs an unrelated procedure or service provided by the same provider or other qualified health care provider during the postoperative period.
CPT Code For Punch Biopsy Reimbursement
Follow these steps to get the correct reimbursement for biopsy services:
The Healthcare providers should use diagnostic biopsies CPT codes 11102 – 11107. Do not bill these codes in conjunction with a screening diagnosis code. Instead, apply the appropriate modifier to the correct code. If applicable, bill modifier 59 (different procedural service) to the biopsy code.
Examine the modifications made by the National Correct Coding Initiative (NCCI). NCCI PTP amendments typically enable a modifier when the biopsy is billed secondary to an adequate procedure but do not usually allow a modifier when billed primarily to a surgical procedure.
Report the proper primary code. Denials will occur if you report the incorrect primary/main code or charge no code. Also, understand the guidelines for coding numerous biopsies.
To represent the biopsy of several lesions using different procedures (e.g., an incisional biopsy of an initial lesion), biopsy codes can be “mixed and matched.”
To code a tangential biopsy for the second lesion, the coder must use just one main code when doing numerous biopsies on the same patient on the same day without a modifier. Therefore, report the highest-valued code first.
If you do many biopsies using the same procedure, record the primary code with the greatest RVU and the matching add-on code for the other biopsies. Then, when billing for biopsy services, document the technique, the number of units, and the location.
Ensure to record that the maximum number of service units does not exceed for a single patient on a single day of service. Medically Unlikely Edits (MUEs) of The Centers for Medicare and Medicaid Services provide the following instructions:
- The coder or biller may bill the CPT 11102, CPT 11104, and CPT 11106 as one unit per line item.
- The coder or biller can report multiple units on a single line item for CPT 11103, CPT 11105, and CPT 11107.
A patient is an 81-year-old man who has histopathology of basal cell carcinoma of the posterior neck near his hairline and two other sites of concern on his face. After obtaining informed consent, the physician treated the regions and draped them in the usual sterile manner.
The basal cell carcinoma of the neck was the first to get attention. The physician removed the 2.6 cm long lesion, pulling it down to the subcutaneous fat.
After severe undermining, he closed the wound in stages using 4.0 Monocryl, 5.0 Proline, and 6.0 Proline; the damage measured 4.5 cm. Then the physician drew his attention to the other two suspicious spots on his cheek.
After giving a local anesthetic, he promptly took each lesion’s 3 mm punch biopsy. Finally, he was able to close with 5.0 Proline. The patient well tolerated the procedures. Pathology subsequently revealed that he eradicated the basal cell carcinoma, and biopsies revealed actinic keratosis.
The coder may use CPT 13132, CPT 11623 – 51, CPT 11104 – 59, and CPT 11105.