Special FAQ’s for 2019 NEW Biopsy Codes
The AAD coding team has received questions regarding the new 2019 CPT biopsy codes. You will find the answers to frequently asked questions below.
Q) Do you know if all insurance carriers are switching to the new CPT codes for skin biopsies, or does this change just apply to CMS plans?
A) All new 2019 CPT codes, including the biopsy codes (11102-11107), are effective for claims reporting for all payers and healthcare providers as of January 1, 2019.
Q) Regarding the new biopsy codes, there is one piece of information we haven’t been able to locate. What are the new codes’ global period?
A) The new skin biopsy codes have retained the same global days as the previous set of codes, i.e., 0 (zero) global days.
Q) We have billed the following codes (99213-25, 17000, 17003, and 11102-59); however, Medicare has denied payments for codes 17000 and 17003. The denial code is CO-4 (the procedure code is inconsistent with the modifier used or a required modifier is missing).With the previous biopsy code 11100, modifier 59 was used on the biopsy procedure and not the cryotherapy procedure. Has this changed with the new codes? We have received multiple denials.
A) The NCCI edits have changed with the new biopsy codes (11102-11107). You will have to rely on CMS’ NCCI edits’ list (an Excel spreadsheet) to understand the more than 25 changes that have occurred. Medicare has a very useful booklet on how to use this tool, which is available at www.cms.gov/ncci (on the left side of the page).
The Academy has also provided information regarding these NCCI changes. A useful guide is available on the Coding page of the Practice Management Center under the modifier 59 tab.
Dr Alexander Miller explains the use of modifier 59 and the new biopsy codes in Derm World’s “Cracking the Code,” Coding in 2019, Biopsies Part 3. More information and examples are available at https://staging.aad.org/dw/monthly/2019/january/biopsy-coding-in-2019-part-3. Q) I performed a skin biopsy of the eyelid (but it did not involve the eyelid margin); is CPT code 67810 the correct code to report?
A) The description for CPT code 67810 states “[i]ncisional biopsy of eyelid skin including lid margin.” Additional instructions in the parenthetical note states that “[f]or biopsy of the skin of the eyelid, see 11100, 11101, 11102, 11103, 11104, 11105, 11106, 11107.” Since the eyelid margin was not involved, 67810 is not the correct code.
Q) Can you clarify the difference between shave removal and tangential biopsy?
A) Although the techniques for a tangential biopsy and a shave removal may be similar, the intent of the procedures creates a difference between the two. The intent of a tangential biopsy is solely to obtain a tissue sample for diagnostic histologic examination, whereas the intent for a shave removal is therapeutic to remove a lesion. When you obtain a biopsy, you must send the tissue for histopathologic examination, whereas a shave removal may not require histopathologic examination of the removed tissue.
Q) Can you please clarify what a “wedge” biopsy (11106) is? I cannot find a clear description of when it should be used.
A) Incisional biopsies are defined as full-thickness tissue sampling. A “wedge” biopsy of the skin is the removal of a triangle-shaped tissue sample that penetrates into the subcutaneous space. As such, it is appropriately reported as an incisional biopsy with CPT code 11106, beginning January1, 2019.
Q) Does a closure have to be billed with the biopsy codes?
A) The new biopsy codes (11102-11107) include simple closure, similar to other integumentary procedures. If it is medically necessary, an intermediate or complex repair may be reported separately.
