Cracking the Code

Coding Multiple Biopsies

When multiple biopsy techniques are performed during the same encounter, it is important to understand the guidance pertaining to proper sequencing of the CPT codes. It is appropriate to only report ONE primary lesion biopsy CPT code (11102, 11104, or 11106). Additional biopsy codes should be assigned as well as proper add-on codes. Incisional biopsies take precedence over punch and tangential biopsy procedures. When reporting these three procedures, coders should report CPT 11106 first for the primary incisional biopsy. CPT 11105 or 11103 should be reported secondly as additional add-on codes.

Q: A 57-year-old female presents for a biopsy of a very painful quick growing lumbar back mass. The mass definitely involves the subcutaneous tissue. After discussing the risks and alternatives regarding the biopsy, the patient agrees to proceed with the procedure. The surgeon sharply incises with an eleven blade into the subcutaneous tissue to take further specimen here and uses a 3mm punch biopsy to take two good pieces out of the slightly lateral aspect on the right side of the mass.
A: CPT 11106, Primary incisional biopsy
CPT 11105, Punch biopsy, additional lesion
CPT 11105, Punch biopsy, additional lesion
Reference: AHA Coding Clinic for HCPCS First Quarter 2019, pages 1-4: Biopsy code changes
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