Monday, October 4, 2021

Coding Skin Biopsies

Skin biopsies are the topic of discussion in this installment of “Spotlight on CPT”.  Skin biopsies involve the removal of tissue to determine if disease is present and to what extent.  Skin biopsy coding in CPT can be performed with one of three methods: tangential, punch, or incisional.  Let’s look at each method in more detail.

First, tangential biopsy involves removal of epidermal tissue and may or may not include removal of deeper tissue from the dermis. This means the biopsy is not considered full-thickness but rather partial-thickness.  Tissue is taken by use of a sharp blade or curette.  Different terms for this type of biopsy include shave, saucer, scoop, or curette.  CPT codes 11102 and add-on code 11103 are assigned for tangential skin biopsies.




An area of confusion that surrounds tangential biopsies is the difference between them and a shave removal (11300-11313).  Shave removals are performed in order to remove an entire lesion for a therapeutic reason.  An example is an elevated lesion on a man’s chin that is continually nicked when he trims his beard.  The medically performed shave removal would fall into the code range of 11310-11313 based on the size of the lesion.  If there is any ambiguity surrounding the purpose of the shave procedure, then the provider should be queried so the appropriate category of code can be assigned.

The next type of skin biopsy is the punch biopsy.  This is considered a full-thickness biopsy procedure as a cylindrical tissue sample is obtained using a punch tool.  These punch biopsies are coded to 11104 or add-on code 11105.











The final type of skin biopsy is the incisional biopsy.  Like the tangential biopsy, a sharp blade is used but, in this case, a full-thickness incisional is made extending through the dermis into subcutaneous tissue.  CPT codes 11106 or add-on code 11107 are assigned when incisional biopsies are performed.  If an entire lesion is removed by incision, the CPT code range would be 11400-11646.












Closure is not generally performed with skin biopsies, but should simple closure be utilized, especially for punch or incisional biopsies, it is not separately reportable.

It is important to note that each of the add-on codes is for each separate/additional lesion biopsied.  Therefore, if three tangential biopsies are performed on three different lesions assign 11102, 11103, and 11103.  There is a hierarchical status to these biopsy codes as well with incisional taking the top priority in coding if multiple types of skin biopsies are performed during one encounter.  Punch biopsies take precedence over tangential biopsies. 

There is an extensive section of notes in the CPT manual which precedes these skin biopsy codes providing detail for assigning the biopsy codes and how to address the hierarchy.

Now, light has been shed on coding skin biopsies.


About the Author 
Dianna Foley, RHIA, CHPS, CCS, CDIP  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.