Biopsy and Injection Coding

May 25, 2017

If my physician reports a biopsy on the same date as an intralesional injection (different sites) can I report both codes? Should I use Modifier 59?

You can report a biopsy (11100) for the first lesion and 11101 for each additional lesion biopsied. You may also report an intralesional injection (11900) on the same date of service if performed on a different lesion.

Modifier 59 should not be reported as it is not bundled under the National Correct Coding Initiative (NCCI). You should only use Modifier 59 if the two codes are bundled under NCCI and both procedure are distinct and separate. In this case since the two codes are not bundled, you should append Modifier 51 (multiple procedures) to CPT 11900 if your payor accepts the use of this modifier. Since 11900 has a lower RVU, Modifier 51 supports this as a secondary procedure. Expect payment to be reduced by 50% for the second procedure.

*This response is based on the best information available as of 05/25/17.


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