Cracking the Code
Coding of biopsies can be found in the 11102-11107 series in the integumentary section of the CPT code book. ‘Biopsy’ within the integumentary system specifically refers to biopsies of the skin. A biopsy is a procedure to remove a piece of tissue or a sample of cells from your body so that it can be tested in a laboratory. For example, when the provider performs a punch biopsy of a lesion, a punch tool is used to obtain a circular sample of the lesion. Typical sizes are 3 mm, 4 mm, or 5 mm. Sutures often are needed to close the defect. Simple closure repair is included in the service and not reported separately. When more than one biopsy is performed by different techniques during the same encounter, only one primary biopsy code is reported and the add-on codes for the other techniques are used. Refer to the CPT guidelines in how different biopsy techniques are reported in the same encounter.
A shave biopsy occurs when the provider uses a sharp instrument, such as a scalpel, and excises the suspicious lesion as close to the base of the lesion as possible. When the provider chooses to do a shave biopsy, the wound is usually only covered by a bandage and usually does not require suturing.
Additional skin biopsies are reported by add-on codes for each additional lesion biopsied. Obtaining tissue for biopsy during an excision, destruction, or shave removal of lesions is not reported separately. Biopsy for pathological examination must be unrelated to other procedures provided at the same time. Please note, there are parenthetical instructions that indicate specific biopsy codes performed on certain anatomical areas. For example, a biopsy of the lip is not reported with an integumentary biopsy code but is reported with code 40490.