In case you're reporting biopsy codes CPT 11100 and CPT 11101 distinctly from excisions or additional biopsies, you're unknowingly going in the trap of denials and even a possible audit. In order to side-step these problems, you must use 11100/11101 when the surgeon gets a portion of a lesion for pathology only. Read the following article and know when you should use these biopsy skin add-on codes to ensure accurate claims.
Instructional notes make it clear that you must not report CPT 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) and +11101 (… each separate/additional lesion [list separately in addition to code for primary procedure]) along with excision or other biopsy codes,
Notes prior to the “Biopsy" portion of CPT say:
You should report CPT 11100 as well as CPT 11101 only when the physician gets hold of a specimen: For instance, the surgeon does away with a part of a patient's skin lesion (709.1, Vascular disorders of skin) and then sends the specimen to pathology. In that particular case, you would certainly use CPT 11100. You must then allocate add-on code 11101 in combination with 11100 when the surgeon conducts a biopsy of a second lesion. You may report one added unit of CPT 11101 for each additional biopsy the surgeon carries out.
Source URL :- http://www.supercoder.com/coding-newsletters/my-general-surgery-coding-alert/biopsy-and-excision-at-the-same-time-think-again-article
You can't report CPT 11100 and CPT 11101 when you bill for a different procedure, for instance an excision. For instance, assume that the surgeon get rid of a whole lesion and after that submits it to pathology, you must then use only 11400 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 0.5 cm or less). You are not supposed to use a biopsy code, as according to CPT, the biopsy is a component of 11400.
When the surgeon carries out a biopsy on a dissimilar site from the excision, you may separately assign CPT 11100 and CPT 11101. For instance, your surgeon does away with an all-inclusive benign lesion from a patient's arm, and also a part of a lesion on a patient's neck. As far as the arm lesion is concerned, use 11400, and as far as neck biopsy is concerned, report 11100-59 (Distinct procedural service). By means of appending modifier -59 to the second code, you specify that the biopsy took place at a distinct location from the lesion removal.
Instructional notes make it clear that you must not report CPT 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion) and +11101 (… each separate/additional lesion [list separately in addition to code for primary procedure]) along with excision or other biopsy codes,
Notes prior to the “Biopsy" portion of CPT say:
You should report CPT 11100 as well as CPT 11101 only when the physician gets hold of a specimen: For instance, the surgeon does away with a part of a patient's skin lesion (709.1, Vascular disorders of skin) and then sends the specimen to pathology. In that particular case, you would certainly use CPT 11100. You must then allocate add-on code 11101 in combination with 11100 when the surgeon conducts a biopsy of a second lesion. You may report one added unit of CPT 11101 for each additional biopsy the surgeon carries out.
Source URL :- http://www.supercoder.com/coding-newsletters/my-general-surgery-coding-alert/biopsy-and-excision-at-the-same-time-think-again-article
You can't report CPT 11100 and CPT 11101 when you bill for a different procedure, for instance an excision. For instance, assume that the surgeon get rid of a whole lesion and after that submits it to pathology, you must then use only 11400 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 0.5 cm or less). You are not supposed to use a biopsy code, as according to CPT, the biopsy is a component of 11400.
When the surgeon carries out a biopsy on a dissimilar site from the excision, you may separately assign CPT 11100 and CPT 11101. For instance, your surgeon does away with an all-inclusive benign lesion from a patient's arm, and also a part of a lesion on a patient's neck. As far as the arm lesion is concerned, use 11400, and as far as neck biopsy is concerned, report 11100-59 (Distinct procedural service). By means of appending modifier -59 to the second code, you specify that the biopsy took place at a distinct location from the lesion removal.
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