Discover Site-Specific Bx Codes and Net $78 or More

Enhance claims accuracy by side-stepping these common biopsy coding difficulties.

In case you automatically assign 11100 when your dermatologist lays down the biopsy site, you could be losing deserved pay. Read this article to know what ICD-9 codes and CPT codes apply to this situation and ensure medical coding accuracy.

Site-specific codes increase medical coding accuracy. Besides, they pay more than the most extensively used code, 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion).

Don't Miss More Pay for More Work

Site-specific biopsy codes inform the payer that the dermatologist carried out a biopsy at a specific site, instead of a generic integumentary based biopsy (11000). A site-specific biopsy code also signifies a more complex procedure than 11000 does.

Result: The dermatologist is worthy more pay for the gretaer level of complexity of these site-specific procedures. Your practice is missing income and accuracy in medical coding in case your dermatologists ignore these site specific codes, which is easy to do as dermatology practices depend on on the integumentary segment of the CPT® manual.

Example 1: A patient comes to your practice with a papular lesion of the lip. Once the dermatologist examines the patient, he decides that he must carry out a biopsy.

In this scenario, you must report 40490 (Biopsy of lip) in place of of 11100. Provided that the dermatologist notes the site-specific biopsy within the documentation, you must get nearly $78 more for the procedure on the patient's lip than in case you had reported 11100 as this biopsy needed more work from the dermatologist.

Don't miss: For accurate medical coding, ensure that the biopsy is of the lip, not the skin surrounding.

Example 2: A patient with a pigmented lesion that is of the nail bed presents to your practice. The dermatologist doubts trauma but feels he should carry out a nail bed biopsy to rule out melanoma.

Your initially thought in coding this scenario could be to bill 11100. However, you should bill 11755 (Biopsy of nail unit [e.g., plate, bed, matrix, hyponychium, proximal and lateral nail folds] [separate procedure]).

Code 11755 is more precise and also pays around $25 more than code 11100 (3.81 non-facility RVUs x $33.9764 = $129.45).

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Report Multiple Biopsies for Separate Sites

While your dermatologist carries out multiple biopsies, you require a tool to unravel the claim's payment. You must clarify the conditions to the payer by the means of modifiers.

Wait for Path Report to Choose Dx

ICD-9 Codes and CPT Codes: You must always wait until the pathology report comes back to select the appropriate codes to report, although this will not always affect the CPT codes you will wind up selecting.

Reason: The biopsy specimen's pathology will affect the ICD-9 codes you report, but most CPT codes are not based on the specimen's outcomes. There are a few CPT codes which are connected to definite diagnoses (for instance, excision of benign and malignant lesions).