Skin Deep: How to Properly Code for Biopsies and Lesion Removal

 

Learn about the new skin biopsy codes, and follow these tips to make sure you get full credit for the skin procedures you perform.

Fam Pract Manag. 2019 Mar-Apr;26(2):15-19.

Author disclosure: no relevant financial affiliations disclosed.

It is often easier for family physicians to perform skin procedures than it is to correctly code for them. The codes are complicated, and many electronic health record systems and even the CPT manual use different terms than physicians use to describe these services. Incomplete or unclear documentation can lead to submitting lower-valued codes, which not only reduces practice revenue but also lowers physicians’ work relative value units (wRVUs), affecting their productivity-based compensation.

Correct coding for skin procedures is not impossible. This article will detail how to code for two types of common skin procedures — biopsies and destruction of lesions — as well as how to code when multiple skin procedures are performed on the same day. The “Skin care encounter form” features codes for the skin procedures most commonly performed by family physicians.

KEY POINTS

  • CPT created new codes in 2019 for tangential, punch, and incisional biopsies and deleted two old biopsy codes.

  • Codes for shave and excisional biopsies, as well as destruction of benign, premalignant, and malignant lesions and skin tags, have not changed.

  • When performing multiple skin procedures for the same patient on the same day, report the highest-valued code first, without a modifier.

SKIN CARE ENCOUNTER FORM

 Download in PDF format

PERFORMING BIOPSIES USING THE 2019 CODES

CPT deleted skin biopsy code 11100 and add-on code 11101 this year and introduced three base codes and three add-on codes that are defined by the method of biopsy — tangential, punch, or incisional — rather than size or anatomic location. (See “New biopsy codes.”) Simple closure, when needed, is included in the payment for all three biopsy types and should not be billed separately. If you need to manipulate the wound to get the edges to align, that is also not separately billable.

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NEW BIOPSY CODES

CPT codeDescriptionwRVUTotal nonfacility RVUsGlobal days

11102

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

0.66

2.80

0

+11103

Each additional lesion

0.38

1.51

N/A

11104

Punch biopsy of skin (including simple closure, when performed), single lesion

0.83

3.52

0

+11105

Each additional lesion

0.45

1.73

N/A

11106

Incisional biopsy of skin (e.g., wedge; including simple closure, when performed), single lesion

1.01

4.26

0

+11107

Each additional lesion

0.54

2.04

N/A

NEW BIOPSY CODES

CPT codeDescriptionwRVUTotal nonfacility RVUsGlobal days

11102

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

0.66

2.80

0

+11103

Each additional lesion

0.38

1.51

N/A

11104

Punch biopsy of skin (including simple closure, when performed), single

ABOUT THE AUTHOR

Betsy Nicoletti is a speaker and consultant in coding education, billing, and accounts receivable. She lives in Northampton, Mass.

Author disclosure: no relevant financial affiliations disclosed.

 
 

Copyright © 2019 by the American Academy of Family Physicians.
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