Understanding Skin Biopsy Codes

March 23rd, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Categories:   Dermatology|Plastic Surgery   Primary Care|Family Care   Oncology|Hematology  

A biopsy is a procedure to obtain only a portion of a lesion for a pathologic exam. According to the AMA, "The use of a biopsy procedure code (e.g., 11102, 11103) indicates that the procedure to obtain tissue for pathologic examination was performed independently, or was unrelated or distinct from other procedures/services provided at that time."

If only a portion of a lesion is removed to determine its pathology, you should use a biopsy code 11102-11103. If the entire lesion is removed, you also have the option of reporting the shave removal codes 11300-11313 and excision codes for lesions 11400-11646, even if the lesion was sent to pathology.

TIP: Watch for sections with malignant codes and sections for benign lesion codes.

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia, 11420-11426.

Excision, malignant lesion including margins, trunk, arms, or legs, 11600-11606.

The difference between partial-thickness vs. full- thickness

  • Partial-thickness
    • When sampling only a portion of the thickness of skin or mucous membrane (does not penetrate below the dermis or lamina propria).
  • Full-thickness
    • Sampling deep into the tissue, to the dermis or lamina propria, into the subcutaneous or submucosal space

Three distinct Techniques

  • Tangential Biopsy 11102, 11103
    Performed with a sharp blade (e.g., shave, scoop, saucerize, curette) like a flexible biopsy blade, obliquely oriented scalpel, or a curette to remove a sample of epidermal tissue, this can be with or without portions of the underlying dermis. Removal of skin tags has their own set of codes 11200, 11201 not to be confused with lesions. Therapeutic removal using shave technique can also be done as a tangential biopsy using CPT codes, 11300-11313; these are reported for reasons such as a symptomatic lesion that rubs on a waistband or bra, the provider must indicate the purpose of the procedure.  

  • Punch Biopsy 11104, 11105
    A punch biopsy is used to obtain a cylindrical tissue sample. A simple closure is included in this procedure.

    Incisional Biopsy 11106, 11107
    This procedure also requires a sharp blade, and an incisional biopsy will allow the provider to obtain a full-thickness sample via a vertical incision or a wedge deep into the dermis, into the subcutaneous space.

Other types of biopsies in specific anatomic sites will be found through the CPT manual as well such as the following:

Nail Unit  11755 Intranasal  30100
Lip 40490 Vestibule of Mouth 40808
Tongue 41100 Floor of Mouth 41108
Penis 54100 Vulva or perineum 56605. 56606
Eyelid skin including lid margin 67810 Conjunctiva 68100
Ear 69100


Any combination of biopsies can be reported if applicable as in this example;

  • If a punch biopsy is performed, report 11104 in combination with two tangential (11103), and one punch (11105), for the additional punch biopsy procedures. Use the applicable add-on code if multiple biopsies of the same type are performed; for example, use the add-on code 11105.

11104 X 1, 11103 X 2, 11105 X 1

Only one primary lesion biopsy code is reported during the same encounter using 1110211104, or 11106. You can, however, report multiple techniques during the same encounter.

Lesions are billed as separate units of service if samples are taken from different lesions and separate sites.

If a large lesion is sampled at several separate locations or sites using a single biopsy code, then only one code should be reported.


Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.

Latest articles:  (any category)

Artificial Intelligence in Healthcare - A Medical Coder's Perspective
December 26th, 2023 - Aimee Wilcox
We constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities? 
Specialization: Your Advantage as a Medical Coding Contractor
December 22nd, 2023 - Find-A-Code
Medical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.
ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD)
December 19th, 2023 - Aimee Wilcox
Chronic respiratory disease is on the top 10 chronic disease list published by the National Institutes of Health (NIH). Although it is a chronic condition, it may be stable for some time and then suddenly become exacerbated and even impacted by another acute respiratory illness, such as bronchitis, RSV, or COVID-19. Understanding the nuances associated with the condition and how to properly assign ICD-10-CM codes is beneficial.
Changes to COVID-19 Vaccines Strike Again
December 12th, 2023 - Aimee Wilcox
According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.
Updated ICD-10-CM Codes for Appendicitis
November 14th, 2023 - Aimee Wilcox
With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.
COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli
COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli
2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....

Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association