Excisional Biopsy

The insurance denied as cosmetic procedure 19101-biopsy of breast, open.
The doctor made a procedure Excisional Biopsy for pathologic evaluation.
The Doctor Diagnosed Nevus, non-neoplastic.
Can you please help me what is the right procedure code for this?

Thank you

Jan 16th, 2013 - youngblood 278

re: Excisional Biopsy

If your doc *knew* it was benign, then it is cosmetic. If your doc was unsure and did the Bx to confirm, then it was neoplasm, uncertain behavior.

Jan 16th, 2013 - ch76606 123

re: Excisional Biopsy

I disagree with that. You are supposed to wait for the pathology report to come back before giving a diagnosis.

Jan 16th, 2013 - nmaguire 2,606

re: Excisional Biopsy

A biopsy is the partial removal of tissue in order to gain a pathologic diagnosis, while the excisional technique represents the removal of the entire lesion and should be coded accordingly. In CPT® , an incisional biopsy is simply referred to as a "biopsy," while an excisional biopsy, simply as an "excision." Usually the excisional biopsy removes the entire lesion.

Jan 16th, 2013 - ch76606 123

re: Excisional Biopsy

I would consider using any signs and symptoms to show medical necessity for the procedure.