Q&A Biopsy Codes (include excision)

[CHWI]

Can anyone please clarify for me the issue with codes 11100 and 11101? the instructional notes say that when a biopsy is performed, the excision is included and should not be coded separately.

However almost any specimen is sent for pathologic examination - so say I have a cyst removed or anything else and its sent to path, if I code with 111000 its WRONG.

what exactly is included and what not? please explain when to use excision, cutting & parring etc.. and when to use biopsy codes! Thanks

 

[Ruth Sheets]

Some background info from Supercoder,
11100
Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; single lesion

Definition of biopsy: A biopsy is a tissue sample that the physician excises from the patient to ascertain the presence of cancer.

Code 11100 is used for when the physician removes a part of a skin, subcutaneous tissue, or mucous membrane lesion for pathological analysis.
Read this last sentence above as "Code 11100 is used for when the physician removes a part of a skin, subcutaneous tissue, or mucous membrane lesion for pathological analysis and nothing else."
Now for an example:

For example, if the physician is excising a lesion from the neck, that has 0.5 cm excised diameter, and that lesion is sent to the path lab, and it is determined to be benign, code 11420 would be coded. The biopsy is included in 11420, so it would be wrong to also code 11100. The physician did more than take a sample for the lab: she removed the whole lesion!

Hope I've been clear.

 

[Ruth Sheets]

Another thing... the instructional note does not say that the biopsy includes the excision. It says an excision includes the biopsy.