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Shaving vs Excision vs Tangential Biopsy

Jamie Posted Tue 11th of June, 2019 19:57:17 PM
CPT has a new code for Tangential Biopsy of Skin(Includes scoop, shave, saucerize, curette) CPT 11102. Can this code be used for a complete scoop-saucerization excision or just a biopsy(sample of tissue) ?
SuperCoder Answered Wed 12th of June, 2019 07:13:42 AM

Hi Jamie,

 

As the code descriptor of CPT code 11102 states tangential biopsy of skin performed through shaving or shave biopsy, scoop biopsy, saucerization/excision or curette of a single lesion is all considered under CPT code 11102. 

 

Hope, provided information would be helpful.

 

Thanks!

Jamie Posted Wed 12th of June, 2019 12:56:21 PM
I thought the purpose of biopsy codes was to obtain a tissue sample of a lesion and not completely removing a lesion? Is this code can be used for complete removal of a lesion that the provider sends to path then what would be the purpose of shave cpt codes?
Jamie Posted Wed 12th of June, 2019 13:00:05 PM
Just trying to make sure we are coding a procedure correctly due to this new code causing confusion.... The provider documented: Procedure note: The lesion was anesthetized with 2% lidocaine & epinephrine. The area was prepped with betadine. Using sterile techique a scoop-saucerization excision removed lesion completely as well as 2mm deep was obtained and sent for pathology with 1mm lateral margins. Bleeding was minimal and controlled with Drysol. Patient tolerated the procedure well. Size: 1 x 0.5 cm , L hand EBL:<1cc Complications:none Area was dressed and given post-op instructions Lesion was sent for pathology
SuperCoder Answered Thu 13th of June, 2019 04:06:55 AM

Hi Jamie,

 

As per the provided procedure note, CPT code 11102 still would be the code of choice. Do not get confused with excision codes. Provider may remove a complete lesion by shave biopsy also.  

 

In this procedure (CPT code 11102), provider uses a flexible blade to shave off the portion of a lesion, such as a seborrheic keratosis, that is above the level of the surrounding skin. Alternatively, using a similar blade but holding it so that it is bent into an arc, he passes the blade through the thicker inner layer of the skin and possibly into subcutaneous tissue to remove a vesicular or bullous lesion, keeping the capsule intact. Additionally, he may use an angled scalpel or a curette, a spoon or scoop–shaped surgical instrument, to scrape a lesion from the skin. Sutures are generally not needed for this type of biopsy. He places an adhesive bandage and sends the specimen to the pathology lab for analysis.

 

Hope, provided information would be helpful.

 

Thanks!

Jamie Posted Thu 13th of June, 2019 11:41:52 AM
Usually when our providers do a shave and send the lesion for biospy we have always coded a CPT code from the shaving of epidermal or dermal lesions...so sounds like with this new code is depends on the providers intent, as is seems both codes could be used in the same way, but based off the intent on why the procedure is being done?
SuperCoder Answered Fri 14th of June, 2019 03:31:25 AM

Hi Jamie,

 

We do understand this code can lead to confusion but if you follow the intent and the procedure type (way the procedure was performed), things will become easier. Always use this code for shaving, scooping, saucerization or curette performed through tangential approach. There are other ways in which biopsies are performed like punch biopsy or incisional biopsy. This is approach-based code. There are separate CPT codes for procedures performed through punch or incision. 

 

Hope provided information would be helpful.

 

Thanks!   

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