06/02/2017

Coding for 4 Punch Biopsies

A patient presents with a blistering dermatitis. A call is placed to a pathology lab asking for assistance. The lab recommends taking 2 different punch biopsies of a blistering lesion in different stages of the blister and to place this in formalin and then do the samething and place in Michelles fixative. hence, a total of 4 punches are taken of the same condition but at different locations on the foot. (local anesthesia is used before the punch). What is the correct way to bill for these 4 punches?

For a punch biopsy, two procedure codes should be reported to the patient’s insurance, depending on the number of lesions that are sent to dermatopathology for analysis:

Code Description

• 11100: Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; single lesion

Lay Description:

The physician removes a biopsy sample of skin, subcutaneous tissue, and/or mucous membrane for histologic study under a microscope. A single lesion is biopsied in 11100. Report 11101 for each separate lesion biopsied in addition to the primary procedure. Some normal tissue adjacent to the diseased tissue is also removed for comparison purposes. The excision site may be closed simply or may be allowed to granulate without closure

Coding Tips

As an "add-on" code, 11101 is not subject to multiple procedure rules. No reimbursement reduction or modifier 51 is applied. "Add-on" codes describe additional intra-service work associated with the primary procedure. They are performed by the same physician on the same date of service as the primary service/procedure, and must never be reported as a stand-alone code. Use 11101 in conjunction with 11100. For biopsy of a mucous membrane of the vestibule of the mouth, see 40808. It is inappropriate to report supplies when these services are performed in an emergency room. For physician office, supplies may be reported with the appropriate HCPCS Level II code. Check with the specific payer to determine coverage.

Code Description

• 11101: Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; each separate/additional lesion (List separately in addition to code for primary procedure)

Lay Description:

The physician removes a biopsy sample of skin, subcutaneous tissue, and/or mucous membrane for histologic study under a microscope. A single lesion is biopsied in 11100. Report 11101 for each separate lesion biopsied in addition to the primary procedure. Some normal tissue adjacent to the diseased tissue is also removed for comparison purposes. The excision site may be closed simply or may be allowed to granulate without closure

Coding Tips:

As an "add-on" code, 11101 is not subject to multiple procedure rules. No reimbursement reduction or modifier 51 is applied. "Add-on" codes describe additional intra-service work associated with the primary procedure. They are performed by the same physician on the same date of service as the primary service/procedure, and must never be reported as a stand-alone code. Use 11101 in conjunction with 11100. For biopsy of a mucous membrane of the vestibule of the mouth, see 40808. It is inappropriate to report supplies when these services are performed in an emergency room. For physician office, supplies may be reported with the appropriate HCPCS Level II code. Check with the specific payer to determine coverage.

The primary PX would be reported once for the first biopsy- the add-on code may only be reported if a biopsy is taken from a different lesion (or blister in this case). If two samples are obtained for blisters in different stages, one unit of the primary procedure (11100), would be billed, and the add-on code (11101) would be billed for one unit.