News

CPT Site-Specific Biopsy Codes: Undercoding Means Underpayment


 

KOLOA, HAWAII — Dermatologists throw a lot of money away by undercoding their site-specific biopsies, Dr. Leon Kircik said at the annual Hawaii dermatology seminar sponsored by Skin Disease Education Foundation.

The CPT code for skin biopsy is 11100. A biopsy performed at a second site is coded 11101, a third is 11102, and so on. But there are other codes intended for use in biopsies of the ear, eyelid, and various other specific sites. (See box.)

All of these site-specific biopsies are assigned higher relative value units and are reimbursed at substantially higher rates than those coded 11100. An eyelid biopsy, for example—coded 67810—pays about five times more, according to Dr. Kircik, a dermatologist in private practice in Louisville, Ky.

"I audited a big practice in New York City where they were putting all the eyelid biopsies as a regular skin biopsy and missing a lot of revenue," he recalled.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

Site-Specific Biopsy Coding

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