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Dermatology Biopsy Codes 2019

Kathy Posted Thu 10th of January, 2019 17:22:01 PM
Per the Claim Scrubber, the biopsy code 11106 and 11102 cannot be billed together, they will disallow/bundle. If we are doing multiple sites, different biopsy types, can different biopsy codes be utilized/paid if a modifier is present to "unbundle"? If so is it more appropriate to use "59" or "XE". As well, I am being told that there is a "hierarchy" to how these codes are billed. Is that correct? If I do 11104, 11102, 11103 qty of 2 and 11106, same day, different sites, what is the correct set up for that claim?
SuperCoder Answered Fri 11th of January, 2019 04:18:47 AM

Hi Kathy,

 

Thanks for your question.

 

Code 11104 is a column 2 code for 11106, These codes cannot be billed together in any circumstances. Code 11104 cannot be billed with 11106.

 

Code 11102 is a column 2 code for 11106, These codes cannot be billed together in any circumstances. Code 11102 cannot be billed with 11106.

 

Code 11103 is an Add-on code. You may report code 11103 in conjunction with 11102, 11104, or 11106 when different biopsy techniques are used to sample separate/additional lesions.

 

Tip: If the provider performs a tangential biopsy of a skin lesion, report 11102 for the initial lesion and +11103 for each additional lesion. If the provider performs a punch biopsy of a skin lesion, report 11104 for the initial lesion and +11105 for each additional lesion. And if he performs an incisional biopsy of a skin lesion, report 11106 for the initial lesion and +11107 for each additional lesion.

 

Please feel free to write if you have any question.

 

Thanks

Kathy Posted Fri 11th of January, 2019 16:52:46 PM
I read that already. I was asking specifically about multiple biopsies on the same day, different types. Is it appropriate to bill and use the 59 modifier if there is a 11106 and a 11102 done on the same day, different sites.
Kathy Posted Fri 11th of January, 2019 16:54:29 PM
I just reread. Sorry, answered the question already. Thank you
SuperCoder Answered Mon 14th of January, 2019 00:39:35 AM

Thank you, happy to help.

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