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Otolaryngology Coding Alert


Opt for Site-Specific Biopsy Code

Question: Should I use 11100-11101 or 69100 for the following operative report: Patient had thickened eschar in his left auricular area with question of recurrence. I took multiple biopsies from the anterior, inferior, superior and posterior. Deep margins were all positive for basal cell carcinoma.

The pathology report states:

A. skin left ear biopsy--basal cell carcinoma (BCA)
B. skin left superior auricular biopsy--BCA infiltrative type
C. skin left posterior auricular biopsy--BCA
D. skin right ear biopsy--BCA
E. skin right superior auricular biopsy--BCA
F. skin right posterior auricular biopsy--BCA.

California Subscriber

Answer: When it's possible to report a site-specific biopsy code, you should. Not only are they more accurate, but they usually pay more than 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion).

In your case, a site-specific code exists: 69100 (Biopsy external ear). Looking up -Biopsy, Ear: External- in the index of the CPT manual will lead you to 69100.

Code 69100 is singular, so you may report the code more than once for multiple biopsies. To indicate that the additional biopsies occur on separate sites, append modifier 59 (Distinct procedural service) to the second- side biopsy codes. You may indicate the body side by using LT (Left side) and RT (Right side) as appropriate. For Medicare, you should enter the following codes using the CMS-1500 form:

For biopsy sites that do not have specific codes, use 11100 and +11101 (... each separate/ additional lesion [list separately in addition to code for primary procedure]). Remember that 11100 is a primary code and 11101 is an add-on code that you should report per additional biopsy. Because 11101 is an add-on code, it is modifier 51 exempt. So, report biopsies of six facial lesions as:

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