Location codes
Location: In a nutshell
- For some procedures, there are different codes for specific anatomical regions.
- There are site-specific biopsy and destruction codes available, and these codes should be reported as long as the coding criteria and guidelines are met.
- You need to pay close attention to where one body part ends and another begins.
CPTTM and ICD-10-CM specify various procedural and diagnostic codes based on both the procedure and the lesion location. Some biopsy and destruction codes can be used for broad anatomical regions, while others — particularly those for procedures on the head, face, and genitalia — can only be used for specific parts of the anatomic location.
When you’re coding for a biopsy or destruction, noting a general location might not cut it. If there is a code that’s more specific, that’s the one that’s more likely to get you the correct reimbursement .
Document the precise location carefully. Just writing “biopsy of the ear” will likely result in the payer denying the claim. Ensure your coding and billing team are adequately trained to recognize the location specificity of the biopsy or destruction code as indicated in your medical record documentation, and to assign the appropriate code.
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If you want to be reimbursed appropriately for your services, it’s important to become familiar with the location-specific biopsy codes associated with some biopsy, destruction, and excision coding.
Location, location, location
The skin biopsy codes can be reported for most locations, however some areas such as the lips and eyelids bring you into complex territory. While they are relatively small parts of the body, there are codes for each specific location.
Skin biopsies
| Location | CPT code | Additional information |
|---|---|---|
Lips |
40490 |
Specific to the lip internal to the vermillion border (on the lip vermillion or mucosa). However, if your biopsy is just on the skin of the lip, you only need to use the skin biopsy code, based on technique (1110X). |
Eyelids |
67810 |
Refers to incisional biopsy of the eyelid skin, including the lid margin. This code is limited to procedures where the full thickness of the eyelid margin — the portion of the eyelid edge that extends from the skin and lash line to the palpebral conjunctiva — is biopsied. If you perform a biopsy on the eyelid, but only involve the eyelid skin, without lid margin involvement, report the CPT code 1110X for biopsy of the skin. |
Ear |
69100 |
Includes biopsy, by any technique, of the skin of only the external ear. However, if the biopsy is of the skin within the external auditory canal, report the CPT code 69105. |
|
There are also location specific codes for destruction codes. While it may be tempting to report a universal integumentary code, for sites that have a dedicated procedure code, the most specific codes should be selected.
Destructions
| Location | CPT code | Additional information |
|---|---|---|
Anus |
46900 |
Simple; by chemical means |
46910 |
Simple; by electrodesiccation |
|
46916 |
Simple; by cryosurgery |
|
46917 |
Simple; by laser surgery |
|
46922 |
Simple: surgical excision |
|
49924 |
Extensive; by any means |
|
Mouth |
40820 |
Includes any means of destruction for lesions or scar of the vestibule of the mouth |
Penis |
54055 |
Simple; by electrodesiccation |
54056 |
Simple; by cryosurgery |
|
54057 |
Simple; by laser surgery |
|
54060 |
Simple: surgical excision |
|
54065 |
Extensive; by any means |
|
Vulva |
56501 |
Simple; by any means |
56515 |
Extensive; by any means |
|
Eyelid |
67850 |
Lesion up to 1 cm of the lid margin *For excision of lesions of the eyelid (except chalazion) that involve the lid margin, tarsus, and/or palpebral conjunctiva without closure or with simple direct closure report CPT code 67840. |
Code 67850 is for destruction of lesions of the lid margin (up to 1 cm) and is used when the destroyed lesion is located on the lid margin. But if the lesions you’re destructing are located on skin outside of the lash line, you need to specify with the appropriate pre-, malignant-, or benign- destruction codes.
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