Coding Biopsies
Coding of biopsies can be found in the 11102-11107 series in the integumentary section of the CPT code book. ‘Biopsy’ within the integumentary system specifically refers to biopsies of the skin. A biopsy is a procedure to remove a piece of tissue or a sample of cells from your body so that it can be tested in a laboratory. For example, when the provider performs a punch biopsy of a lesion, a punch tool is used to obtain a circular sample of the lesion. Typical sizes are 3 mm, 4 mm, or 5 mm. Sutures often are needed to close the defect. Simple closure repair is included in the service and not reported separately. When more than one biopsy is performed by different techniques during the same encounter, only one primary biopsy code is reported and the add-on codes for the other techniques are used. Refer to the CPT guidelines in how different biopsy techniques are reported in the same encounter.
A shave biopsy occurs when the provider uses a sharp instrument, such as a scalpel, and excises the suspicious lesion as close to the base of the lesion as possible. When the provider chooses to do a shave biopsy, the wound is usually only covered by a bandage and usually does not require suturing.
Additional skin biopsies are reported by add-on codes for each additional lesion biopsied. Obtaining tissue for biopsy during an excision, destruction, or shave removal of lesions is not reported separately. Biopsy for pathological examination must be unrelated to other procedures provided at the same time. Please note, there are parenthetical instructions that indicate specific biopsy codes performed on certain anatomical areas. For example, a biopsy of the lip is not reported with an integumentary biopsy code but is reported with code 40490.
Q: A 34-year-old female patient arrives at the dermatologist with a suspicious lesion on her left arm and another one on her right arm. After examination, the physician feels these lesions present as highly suspicious and obtains consent to perform punch biopsies on both sites. After prepping the area, the physician injects the sites with Lidocaine 1 percent and .05 percent Epinephrine. A 3 mm punch biopsy of the lesion of the left arm and a 4 mm punch biopsy of the lesion of the right arm is taken. The sites are closed with a simple one-layer closure and the patient is to return in 10 days for suture removal and to discuss the pathology results. The patient tolerated the procedure well.
A: 11104, 11105 Rationale: Look in the CPT Index for Biopsy/Skin Lesion/Punch and you are directed to 11104, 11105. Code 11104 is reported for biopsy of the first lesion of the left arm and add-on code 11105 is reported for the biopsy of the lesion on the right arm. The simple one-layered closure (simple repair) is included in the codes and is not reported separately.
Reference: FY 2023 CPT code book & guidelines, Mayo Clinic
