July 22, 2021

Question:
What happened to the skin biopsy codes? I submitted a claim for 11101 (skin biopsy) and +11101 (additional lesion) and it was denied for “invalid code.”

Answer:

CPT deleted CPT codes 11100 and +11101, effective 1/1/19, and replaced them with the follow six new codes:

11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single

+11103 each separate/additional lesion (List separately in addition to code for primary procedure)

11104 Punch biopsy of skin (including simple closure, when performed); single lesion

+11105 each separate/additional lesion (List separately in addition to code for primary procedure)

11106 Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion

+11107 each separate/additional lesion (List separately in addition to code for primary procedure)

Note that tangential biopsies are partial thickness, punch biopsies require a punch tool and are full-thickness while incisional biopsies are full-thickness.

If multiple lesions are biopsied utilizing different techniques, only one base code (11102 or 11104 or 11106) should be reported (the highest valued code). An add-on code is reported for the additional biopsies. For example, if one biopsy is performed by punch method and another by incisional method, proper reporting would be 11106 (incisional) and +11105 (punch).

*This response is based on the best information available as of 7/22/21.