Know When You Should Use CPT 11100: Key to biopsy pay
In case you're puzzled about when you should report a biopsy and also when you should select an excision code, ask these simple questions to know when you are supposed to report CPT 11100 and avoid this common dermatology denial trap.
1. Why did the dermatologist do away with the skin abnormality?
When your dermatologist examines a patient who has a suspicious lesion, for instance a mole that transformed it's shape over time or has uneven borders, the dermatologist should remove that lesion.
Caution: Just for the reason that the dermatologist removed the lesion, he didn't essentially conduct a biopsy. Dermatologists send both excisions along with biopsies to pathology, but you must report a biopsy: CPT 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) only in case the dermatologist gets a diagnosis (for instance, 172.x, Malignant melanoma of skin) from the pathology report.
In case the dermatologist actually carried out an excision and did not performed a biopsy, you must report the procedure with an excision code (11400-11646)
2. What is the quantity of the lesion that the dermatologist removed?
The lesion's size or depth generally dictates the removal method. Dermatologists generally carry out superficial shaves to entirely remove lesions for instance surface moles. However in other occurrences, the dermatologist will carry out an excision to get a portion of a more serious lesion, for instance a cyst-like lesion underneath the skin's surface.
In this case, the dermatologist excises a part of the lesion and then sends the specimen to pathology. Then should you code an excision or a biopsy?
Answer: You must report a biopsy code as the dermatologist took only a portion of the lesion meant for a pathology diagnosis. Consequently, in this case, you must bill code CPT 11100 for a single lesion, and add-on code +11101 (… each separate/additional lesion [list separately in addition to code for primary procedure]) in case the dermatologist takes a sample from more than one lesion.
Don't miss: As add-on codes denote the procedures the physician carried out along with a primary service/procedure, you should never report them as individual codes or you will face denials.
Ensure that you look at CPT's parenthetical instructions, which generally inform you which procedure codes you can use along with the add-on code.
Extra: In case the documentation does not evidently state the specimen's size (for instance, the whole lesion or just a sampling), you can always wait for the particulars of the pathology report before you define which code to use: CPT 11100 or CPT 11400 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 0.5 cm or less).
Source URL :- http://www.supercoder.com/coding-newsletters/my-dermatology-coding-alert/procedures-intent-makes-or-breaks-your-11100-reimbursement-article
In case you're puzzled about when you should report a biopsy and also when you should select an excision code, ask these simple questions to know when you are supposed to report CPT 11100 and avoid this common dermatology denial trap.
1. Why did the dermatologist do away with the skin abnormality?
When your dermatologist examines a patient who has a suspicious lesion, for instance a mole that transformed it's shape over time or has uneven borders, the dermatologist should remove that lesion.
Caution: Just for the reason that the dermatologist removed the lesion, he didn't essentially conduct a biopsy. Dermatologists send both excisions along with biopsies to pathology, but you must report a biopsy: CPT 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) only in case the dermatologist gets a diagnosis (for instance, 172.x, Malignant melanoma of skin) from the pathology report.
In case the dermatologist actually carried out an excision and did not performed a biopsy, you must report the procedure with an excision code (11400-11646)
2. What is the quantity of the lesion that the dermatologist removed?
The lesion's size or depth generally dictates the removal method. Dermatologists generally carry out superficial shaves to entirely remove lesions for instance surface moles. However in other occurrences, the dermatologist will carry out an excision to get a portion of a more serious lesion, for instance a cyst-like lesion underneath the skin's surface.
In this case, the dermatologist excises a part of the lesion and then sends the specimen to pathology. Then should you code an excision or a biopsy?
Answer: You must report a biopsy code as the dermatologist took only a portion of the lesion meant for a pathology diagnosis. Consequently, in this case, you must bill code CPT 11100 for a single lesion, and add-on code +11101 (… each separate/additional lesion [list separately in addition to code for primary procedure]) in case the dermatologist takes a sample from more than one lesion.
Don't miss: As add-on codes denote the procedures the physician carried out along with a primary service/procedure, you should never report them as individual codes or you will face denials.
Ensure that you look at CPT's parenthetical instructions, which generally inform you which procedure codes you can use along with the add-on code.
Extra: In case the documentation does not evidently state the specimen's size (for instance, the whole lesion or just a sampling), you can always wait for the particulars of the pathology report before you define which code to use: CPT 11100 or CPT 11400 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 0.5 cm or less).
Source URL :- http://www.supercoder.com/coding-newsletters/my-dermatology-coding-alert/procedures-intent-makes-or-breaks-your-11100-reimbursement-article
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