New Dermatology Biopsy Codes and Modifiers

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Shoshana
Posts: 84
Joined: Fri Jun 23, 2017 1:41 pm
Location: Multi-specialty Clinic

Fri Jan 11, 2019 3:25 pm

I am being asked a question by one of my dermatology providers. Could you help me with this? She wants to know:

With the new biopsy codes Dr. xxxx and the providers have brought up many questions regarding where the 59 modifier should go and also how to bill when you have multiple biopsies and special sites.

Ex: Patient has a 2 punch biopsies done, a shave biopsy on the ear, and 3 more biopsies on the trunk where would the 59 modifier go? What biopsy codes would we use?
1. Punch biopsy code 11104 initial, then 1105 additional; 69100- ear biopsy-shave, now would we use 11103 x 3 for the additional or 11102 then 11103 x2 for the additional? Where would the modifier go?
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admin
Site Admin
Posts: 442
Joined: Mon Apr 09, 2012 1:54 pm

Wed Jan 16, 2019 11:48 am

Hello,

I have included slides from the CPT Changes 2019 Webinar presented by NAMAS that may help clarify the use of the new biopsy codes. All the information in the slides comes directly from the 2019 CPT code book. There are a lot more instructions in this area of the book that are not in the slides, so I recommend reading thru them in addition to this response. Also included below is the table from CPT indicating how to report the codes when multiple biopsies of the same and different techniques are performed.

The skin biopsy codes are now divided by the technique used to obtain the specimen. Each of the techniques has a primary code and an add-on code. The add-on codes are used with any of the parent codes, so multiple techniques would be reported with 1 parent code, then the appropriate add-on code for each additional lesion. When using these codes, modifier -59 is not needed. The provider’s documentation needs to specify the technique in language that will allow appropriate code selection.

In your example, there are 2 punch biopsies, 1 shave biopsy ear, and 3 more on the abdomen that are not specified to the technique. The first answer is assuming they are also shave biopsies. The second answer is given as if the abdominal biopsies were documented as incisional.

11104 x1 1st punch biopsy (parent code)
+11105x1 2nd punch biopsy
+11103x4 4 shave biopsies

11106x1 1st incisional biopsy
+11107x2 2 additional incisional biopsies
+11105x2 punch biopsies
+11103x1 shave biopsy of ear

As you can see in the above examples, only 1 parent code is reported for each case then the appropriate combination of add-on codes. Different parent codes were reported based on the RVUs of the parent codes for each example. I hope you find this information helpful!
tangenital biopsy.png
tangenital biopsy.png (73.1 KiB) Viewed 122 times
punch bx.png
punch bx.png (65.38 KiB) Viewed 122 times
procedures per.jpg
procedures per.jpg (27.98 KiB) Viewed 122 times
Your question has been answered by Pam Vanderbilt, CPC, CPMA, CPPM, CPC-I, CEMC, CEMA
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