FNA – Fine needle aspiration (22 Gauge size to 25 gauge size) small size needle.
(Core biopsy - 14, 16 &18 gauges are
large circumference needle).
1. Without Imaging guidance
CPT 10021 & 10004
2. With Imaging Guidance (First lesion and each additional)
CPT 10005 & 10006 – Ultrasound
Guidance
CPT 10007 & 10008 – Fluoroscopic Guidance
CPT 10009 & 10010 – CT Guidance
CPT 10011 & 11012 – MRI Guidance
All the above codes include Guidance (US, Flu, CT or MRI).
Append modifier 59 for different modality at the same session.
Core and FNA performed at the same site or different site - Bill both
procedure and add modifier 59 with FNA code.
If the Biopsy procedure was not performed using FNA then use respective chapter
codes.
· Breast (19081 –
19086)
· Muscle
(20206)
· Pleura
(32400)
· Lung
(32405)
· Salivary
gland (42400)
· Liver
(47000)
· Pancreas
(48102)
· Abdominal
or retroperitoneal (49180)
· Kidney
(50200)
· Testis
(54500)
· Epididymis
(54800)
· Thyroid
(60100)
· Nucleus
pulposus, IVD, paravertebral (62267)
· Spinal
cord (62269)
Note: With proper supporting documentation both Fine needle and core
needle can be coded with the appropriate modifier.
Integumentary System - Skin, Subcutaneous and accessory structures
Debridement (11042 – 11047)
1.
It is coded based on the
depth of the tissue removed and surface area of the wound.
2. Debridement of a single wound – report the
deepest level only.
3. Multiple wounds – Sum the surface
area of same depth (Don’t combine different depths)
Samples Chart:
Eg: Debridement
of bone from foot ulcer 8 sq cm and 8 sq cm from the back ulcer – Use CPT
11044 (first 20 sq cm or less)
Eg: Debridement
of subcutaneous tissue 18 sq cm trunk wound and 10 sq cm from thigh wound – Use
CPT 11042, 11045 (For first 20 sq cm 11042 and remaining 8 sq cm 11045)
Biopsy of skin
11102 – Tangential biopsy of the skin (i.e., scoop, curette, shave) a
single lesion
11103 – each additional/separate lesion (list separately along with
the code for the primary biopsy)
11104 – Punch biopsy of the skin (including simple closure if
performed) for a single lesion
11105 – every additional/separate lesion (should be listed separately
along with the code for primary biopsy)
11106 – Incisional biopsy of the skin (i.e., wedge) (along with simple
closure, if performed,) single lesion
11107 – every additional/separate lesion (list separately along with
the code for the primary biopsy
Need to code biopsies based on the method of removal.
* Tangential biopsies describe biopsies performed with a sharp blade to take a small portion of epidermal tissue.
* Punch biopsies require using a punch tool to remove a cylindrical,
full-thickness skin sample. Simple closure is included.
* Incisional biopsies are done with a sharp blade and involved removing
full-thickness samples with a wedge or vertical incisions. These biopsies
penetrate into the dermis. Simple closure is included.
A few tips to keep in mind:
Only one primary biopsy code should be reported if more than one biopsy is
performed at the same visit.
If multiple biopsies are performed with the same technique, report the
corresponding biopsy code and then use the add-on code for every additional
lesion that’s biopsied.
If you are excising the entire lesion, you’ll need to use excision codes 11400
- 11646 depending on whether the lesion is malignant or benign
Surgical procedures in the skin like,
- Excision,
- Destruction
(or)
- Shave
removal, Includes biopsy of the skin at the same
site.
Note: If the procedure was performed on different site or different
lesions on the same date would be reported separately with the modifier 59.
Shave Technique
Shaving is the sharp removal by transverse incision or horizontal
slicing to remove epidermal and dermal lesions without a full-thickness dermal
excision.
It doesn’t require suture closure. (Includes local anaesthesia, chemical or
electrocauterization)
CPT 11300 – 11313
CPT’s are arranged based on the anatomical site and lesion
size. Each shaved lesion would be reported separately.
NOTE: A shave removal procedure may vary in depth and width,
and in some instances, it may completely remove a lesion that occupies the
upper or mid dermis. The fact that a lesion is removed in its entirety is
irrelevant when deciding whether to code as a shave removal or an excision.
According to CPT, a lesion may be completely removed, but if the level of
removal does not go through the full thickness of the dermis, it is not an
“excision”.
Excision
1. Benign
lesions (11400 - 11446)
2. Malignant
lesions (11600 - 11646)
Benign lesions (Benign neoplasm, cyst, fibrous, inflammatory,
congenital lesions)
- Full-thickness (dermis) removal
of a lesion including margins (Including simple closure & Local
anesthesia)
- Code separately each benign
lesion excised.
- Code selection is based on
lesion diameter plus narrow margins.
- Any Intermediate /
Complex closure should be reported separately along
with excision codes. (Simple closure is part of the excision procedure hence it
would not be coded separately)
- Excision of a lesion (11400 -
11446) with adjacent tissue transfer – Code only adjacent
tissue transfer (ATT).
Malignant lesions (Basal cell carcinoma, Squamous cell carcinoma,
melanoma)
-
Full-thickness (dermis) removal of a lesion including margins (Including
simple closure & Local anesthesia)
- Code separately each
malignant lesion excised.
- Code selection is based
on lesion diameter plus narrow margins equal.
- Any Intermediate
/ Complex closure should be reported separately along with excision
codes. (Simple closure is part of the excision procedure hence it would not be
coded separately)
- Excision of a lesion
(11600 - 11646) with adjacent tissue transfer – Code only adjacent
tissue transfer.
- Use only one
code to report the additional excision / re-excision based on the
final widest excised diameter required for complete tumor removal at the same
operative session.
To report a re-excision procedure performed to
widen margins at a subsequent operative session use (11600 - 11646) as
appropriate.
Append modifier 58 if the re-excision procedure is
performed during the postoperative period of the primary excision procedure.
Repair (Closure)
Closure of wound may be classified as,
1. Simple
(12001 - 12021)
2. Intermediate
(12031 - 12057)
3. Complex
(13100 - 13153)
Simple repair (One layer closure)
-
Superficial wound (Primarily
involving dermis or epidermis or subcutaneous tissue) Includes local
anesthesia
Intermediate repair (Layered closure)
- Closure involving epidermis, dermis,
subcutaneous tissue, superficial fascia
- Exception: Single layer closure of
heavily contaminated wounds that have required extensive cleaning or removal of
particulate matter.
Complex repair (More than layered closure)
More
extensive
Coding guidelines:
· When multiple wounds are
repaired – add together the lengths of those in the same classification (Simple
with simple repair) and from all anatomic sites that are grouped together into
the same code descriptor
Note: Don’t add together lengths of different
classification (Simple & complex)
Don’t add together lengths of repairs from different
groupings of anatomic sites (Trunk & face)
· When more than
one classification of wounds is repaired – list the more complicated as the
primary and less complicated as a secondary procedure with the modifier 59.
· Simple ligation
of vessels in an open wound is considered as part of any wound closure.
Adjacent Tissue transfer / Rearrangement
Z –plasty,
W-plasty, V-Y plasty, rotation flap, random island flap, advancement flap – Use
CPT 14000 – 14302 (Excision and/ or repair by adjacent tissue transfer)
Don’t code excision codes (11400-11446 &
11600-11646) along with adjacent tissue transfer
Skin
graft to close secondary defect is an additional procedure. Removal
of skin cancer with a histologic examination by the same physician.
Mohs Surgery:
If two different person involves in performing these procedures, code
separately.
The Mohs surgeon removes the tumor tissue and maps and divides the tumor
specimen into pieces and each piece is embedded into an individual tissue
blocks for histopathologic examination.
If repair is performed – use separate code for repair or flap or graft
If a biopsy of suspected skin cancer is performed on the same day as Mohs
surgery in absence of prior study, report skin biopsy with modifier 59.
If the frozen section is performed – Report with modifier 59
Refer the below link for,
_________________________________________________________
Test your Knowledge:
A. Integumentary CPC Sample Quiz