CPT codes 11100 and 11311

If a provider performs a shave biopsy on 1 lesion wouldn't he just bill 11311 (based on size of lesion of course). Provider is wanting to bill 11100 & 11311. I think it should only be 11311 since the specimen is sent out to pathology. Am I overthinking this? Any help is greatly appreciated!


Thank you,
Angela

Comments

  • edited May 2017
    Yes, bill only for the shave removal; code by method the sample was obtained.

    Jen Vasquez, CPC, CEMC

  • Thank you Jen! That is what I thought too. I appreciate your help!

    Angela
  • edited May 2017
    You can bill either one but not both. If the intent was to biopsy a suspicious lesion by shaving then I would bill the biopsy code.

  • Agree with Jan that can bill either code but not both. But...I don't agree the 11100 should be billed because the "intent" was to biopsy. If that was the case then there'd be no reason to ever have shave removals and they should be revised to read shave destructions. Shaving allows more, if not the entirety, of the lesion and allows coding for size and site specific. It's much harder to shave a lesion from somewhere on the face than it is from other areas of the body.

    Here's a link to a really good article on shave removal versus biopsy: http://www.the-dermatologist.com/article/8857

    Hope that helps!

    Kris

    Kris Cuddy, CPC, CIMC
    Healthcare Compliance Analyst
    Compliance Office
    Michigan State University HealthTeam
    East Lansing, MI
    Ofc: 517-355-4547
    Fax: 517-353-5292


  • Happy Friday!! Thank you, Kris and Jan. Thank you Kris for that article, that does help! You guys are awesome!

    Angela
  • Awesome.. such a gray or fine line topic.. we are always going around about this one! :)

    Karyn Cardenas-Foray, CPC, CPMA, CEMC, CIMC
    AHIMA Approved ICD10 Trainer
    Government Reimbursement Analyst
    Sharp HealthCare-PFS/CCD Spectrum
    (858)499-4382 ph.: (858) 499-4300 fax


  • edited May 2017
    The problem I have with this article is first, it is focused on reimbursement which always makes me nervous and second, the provider does not necessarily know they took the entire lesion. If the pathology comes back as malignant or uncertain then what do they do..... they go back in and take more of the lesion deeper tissue. I read an article many years back from the ADA that stated the coding was based on the intent of the procedure.... diagnostic versus definitive treatment. According to them the provider needs to clearly state the intent in the operative report. Sometimes a lesion is shaved because it is irritated by clothing etc and other times the shave is done to determine the nature of the lesion.

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