skin biopsy vs excision

I was asked to biopsy a skin lesion...actually it was more like a rash but with distinct individual areas. I performed a full thickness through the dermis excision/biopsy measuring 1 cm by 2 cm with primary closure requiring several sutures. Should this be coded as a 11100 or a 11402? There's a difference in payment. Also, I read the description of 11402 and the procedure I performed fits. What exactly is the difference between 11100 and 11402? thanks again.

excisional biopsy

If the physician documents excisional biopsy but removes an entire lesion, assign the code for the lesion excision. When only a portion of the lesion is excised, the biopsy code is assigned

biopsy

I recently attended a seminar where a dermatologist stated that Medicare told him if the note says "excisional biopsy" than it must be a biopsy. If it says "Excision of lesion" it may be coded as excision.
However I am not sure where to find those guidelines

biopsy

Excisional biopsy is a misleading term sometimes documented by physicians. Code the excision if it is the removal of the entire lesion. Code and bill what you do and document.

recommendation

Do not use the term excisional biopsy. In coding terms it is either a biopsy or an excision - and it is better to code the excision when this best describes removal of entire lesion. This applies to all lesions when there is a code for biopsy and other code(s) for excision .
A surgical procedure in which an entire lesion is removed for microscopic examination. A surgical procedure in which an entire lump or suspicious area is removed for diagnosis. The tissue is then examined under a microscope.

biopsy vs excision

In my scenario, the patient had a diffuse rash all over his back. The primary wanted a tissue diagnosis. The area I cut out was an individual lesion ("island") but really, it was part of the bigger rash. Is this a biopsy or excision. I understand the issue of removing the whole lesion versus a piece...but really folks, had the lesion/rash been 1 cm I would have done the same procedure...In other words the CPT code changes depending on how big the original lesion is, even though I would not have done a different procedure? Who comes up with this stuff?

Ask Us a Question: biopsy vs excision

Your procedure would be considered a biopsy. After working in a dermatology practice for over 10 years, we billed and were audited on this specific topic. It is not unusual to biopsy any "lesion" of unknown etiology. So, bill the biopsy at 11100.

physician decision based on descriptors

Excision codes are used to reflect “full-thickness” (through dermis) removal of a lesion
Note: Select a CPT code based on lesion diameter plus the most narrow margins required which equals the excised diameter.
Biopsy = removal of small tissue for microscopic examination or culture.
? Biopsies remove a “portion” of a lesion for diagnostic purposes.
? Excisional biopsy = the provider removes the “entire” lesion. This is considered a diagnostic and therapeutic procedure

The physician determines what he/she did.