This page addresses follow-up questions and additional information pertinent to our webinar
Assessing Depth: Biopsy Procedures.
** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.
Q: Sometimes I see the term “excisional” bone biopsy. Is this the same as an “open” bone biopsy? Is there a different code to use for an excisional biopsy?
A: An incisional biopsy removes part of the lesion for examination. An excisional biopsy removes the entire lesion. When is comes to coding for these, the terms do not change the code selection. Per a CPT Assistant from 2004, you would use an open biopsy code for both an incisional and excisional bone biopsy. 20240 or 20245.
Q: Are there medically unlikely edits in place for integumentary biopsies? Specifically tangential, incisional, and punch biopsies?
A: Since each type of biopsy (tangential, incisional, punch) has a code specifically for the first lesion, only one unit of 11102, 11104, or 11106 should be reported.
For the additional lesion codes, the MUEs are listed as 11103 - 6 units, 11105 – 3 units, and 11107 - 2 units. These have a medical adjudication indicator (MAI) of 3. This means that the MUE number listed is based on clinical benchmarks. It might be possible additional units might be considered for payment if documentation adequately supports medical necessity.
Q: Are fine needle aspiration biopsy codes appropriate to use for breast cyst aspirations?
A: A fine needle aspiration for biopsy and a puncture aspiration of breast cyst are represented by different codes. Determine the intent of the procedure, was it a fine needle aspiration for biopsy? Or was it really a puncture for aspiration of a breast cyst (therapeutic)? Use FNA codes if intent is for biopsy. Use codes 19000, 19001 if intent is to drain the breast cyst as the treatment of the cyst.
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Emily Lomaquahu, CPC, CPMA, CEDC
Senior Coding Quality Auditor & Educator
Emily is a Senior Coding Quality Auditor for Haugen Consulting Group and brings over a decade of experience to the profee team! She began her career as an auditor and with her keen eye for detail, she quickly found it was a perfect fit. Emily thrives in a collaborative environment and enjoys creating high-quality trainings to help providers and coders navigate charts and improve their accuracy. She earned a bachelor’s degree from the University of Colorado, in Denver. Emily specializes in Evaluation and Management (E/M), Primary Care, Anesthesia, Emergency Department, and Neurology, though she says Anesthesia and Neurology are her favorites! She is a Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), and Certified Emergency Department Coder (CEDC).