This short article provides basic information. Physicians should consult current Procedural terminology (CPT) guidelines, state regulations, and also payer rules because that coding and also billing guidance appropriate to certain cases. The opinions represented below are those of the author and have no been reviewed, endorsed, or authorized by the American medical Association, the American Academy that Dermatology, or any type of other coding or billing authority.

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Correspondence: Murad Alam, MD, MSCI, 676 N Saint Clair St, Ste 1600, Chicago, IL 60611 ().


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Biopsies, shave removals, and excisions are basic procedures the dermatologists routinely execute to diagnose disease, relax symptoms, and also to treat cancers. Native a coding perspective, these 3 actions are identified differently based upon the intent and also depth that the removal. Committed biopsy password are obtainable for details anatomic sites, and also soft-tissue cut codes can be offered in lieu of conventional skin cut codes for tumors that are confined come the subcutis and below.


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Biopsies are coded once there is an live independence procedure to eliminate skin because that histologic analysis to help establish a definitive histologic diagnosis.Coding for shave removals and excisions requires the will to remove the entire lesion.Unlike shave removals, excisions have the right to be coded just if the lesion is removed to the level of the subcutaneous fat.When available, site-specific biopsy or soft tissue excision password may much better describe a procedure than traditional biopsy or cut codes.

references


1. Present Procedural terminology 2015, skilled Edition. Chicago, Illinois: American clinical Association; 2014.

2. American clinical Association. Biopsy. CPT Assistant. Chicago, IL: American medical Association: October 2004:4.


In dermatology, samples that skin and also subcutaneous tissue are on regular basis removed to create a diagnosis, treat symptomatic lesions, or eliminate potential tumors. The current Procedural hatchet (CPT) codes used in billing because that these procedures typically are generic, yet it is necessary to differentiate in between 3 degrees of tissue removal—biopsy, shave removal, and also excision—when billing for these services because different codes might be ideal in each of this circumstances.

Biopsy

Specifically, biopsy (CPT password 11100/11101) is defined as an “independent…procedure to obtain tissue for pathologic examination.”1 The technique of biopsy is not mentioned by CPT and can include any type of of the following, as long as the main purpose that the procedure is to eliminate tissue because that analysis: removal by scissors, shaving with a blade or dedicated instrument to any kind of level including the subcutaneous fat, extraction using a punch, and excision under to the subcutaneous fat v a scalpel. The function that differentiates biopsy from cut removal or excision is no depth or extent of organization mobilization but the will “to eliminate a part of skin, doubt lesion, or entire lesion so that it have the right to be check histologically.”2 The underlying presumption is the neither critical clinical nor histologic diagnosis exists prior to biopsy, the objective of i beg your pardon is to aid establish the identity of the lesion.

If the tissue within a large, solitary lesion is sampled at number of separate places at the very same visit, then just a single unit that a solitary biopsy password (eg, either 11100, 11101, or some site-specific code) should be reported.In contrast, if a number of discrete lesions in the exact same approximate anatomic area were sampled because that diagnoses, every sample bring away from separate lesions would certainly constitute a distinct biopsy and also would it is in billed together a separate unit that service.

Shave Removals and also Excisions

Shave removed of skin lesions (CPT codes 11300–11313) has the removed of tangential or saucerized skin lesions to a level no deeper than the base of the dermis. The CPT provides no in-depth guidance about differentiation of password for cut removal versus biopsy when a specimen is submitted because that histopathologic examination various other than the definition of biopsy the was disputed previously. If the organization is gotten rid of specifically for creating diagnosis, then by meaning the procedure need to be coded together a biopsy. Top top the various other hand, shave removal means the intent to completely remove a lesion that already has a presumptive clinical or histologic diagnosis or is being eliminated for some purpose other than diagnosis (eg, symptomatic relief).

Shave removals are, however, clearly different 보다 excisions (CPT password 11400–11646), which must proceed v the entire dermis come the subcutis. Additionally, skin lesion excisions include margins, as the will of an cut procedure is to remove the entire lesion along with a margin of normal skin about it.2

Specialized Biopsy and also Excision Codes

While most biopsies, shave removals, and also excisions room performed making use of generic codes, there are devoted circumstances when an ext specific codes may be preferable. Because that instance, there space site-specific skin biopsy codes because that the pond unit (11755), vermilion and also mucosal lip (40490), cock (54100), vulva (56605), and also external ear (69100) the take right into account the extr complexity the biopsy at these anatomic locations. There likewise is a site-specific password for eyelid biopsy (67810), which to be redefined in 2013 together an “incisional biopsy the eyelid skin consisting of lid margin.”1 Therefore, biopsies of eyelid skin that execute not eliminate the eyelid margin must be coded together 11100/11101, or if the whole cutaneous lesion was removed, have the right to be reclassified as cut removals, which would be coded in the 11310 to 11313 range.

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Specialized cut codes encompass those of the soft tissue. Soft tissue excision codes commonly used by dermatologists room not numbered consecutively, are site-specific, and are generally used for resection of bright tumors confined to the subcutaneous tissue listed below the skin but above the deep fascia. Cysts of all types, including epidermoid and pilar cysts, space specifically excluded native this code set regardless that how huge or complicated they may be, as they protrude right into the dermis or over and space not solely in the subcutis. However, lipomas meet the an interpretation for soft-tissue excision, and also therefore site-specific soft tissue excision codes can be provided in lieu of timeless skin cut codes. The soft-tissue excision password are distributed throughout the CPT manual, with distinctive codes for the abdominal wall surface (22902, 22903); leg or fish eye (27618, 27632); earlier or flank (21930, 21931); external auditory canal (69145); top arm or elbow (24075, 24071); face or scalp (21011, 21012); hand or finger (26115, 26111); foot or toe (28043, 28039); forearm or wrist (25075, 25071); hip or pelvis (27047, 27043); thigh or knee (27327, 27337); neck or anterior thorax (21555, 21552); and also shoulder (23075, 23071). In general, there room 2 codes for each area—one because that smaller and one for bigger excisions—but they generally are out of order (ie, the code connected with a higher numerical value may correspond v the smaller sized excision). Care should be taken in selecting the correct code. The specific size cutoffs for the assorted soft organization excision code sets room different, so it is crucial to be acquainted with the particular CPT descriptions for each.