04/20/2022

Billing for Wound/Open Ulcer-Left Ankle-Debridement and Shave Biopsy

I had a patient with a wound/open ulcer left ankle;this is chronic.I debrided it and did a shave biopsy(to rule out malignancy).Do I bill the ulcer and its CPT or the biopsy and its ICD?

Claim should be billed with the appropriate ulcer debridement (CPT 11042-11044, depending on the depth of the ulcer) with appropriate diagnosis code. The shave biopsy could be billable if it is being done for a different reason than the debridement. Since the biopsy is being done as a precaution to rule out malignancy as part of the ulcer debridement, the minor procedure would be considered inclusive to the ulcer debridement. Since a distinct diagnosis can’t be billed on the biopsy to have it considered separately from the ulcer debridement, that minor procedure should not be billed on the claim since it is inclusive to a more comprehensive service performed on the DOS.