July 11, 2019 Question: Can we perform Mohs surgery without a pathology report? Answer: If you review CMS and other payor policies they all require a recent pathology report usually no more than 3 months old confirming the malignancy prior to performing Mohs surgery. *This response is based on the best information available as of...
June 20, 2019 Question: I destroyed 8 AKs and 3 SKs on a patient and also took a shave biopsy of another site. My codes are 17000, 17003 X 7, 17110, and 11102. Do I use modifier 51 or 59? I get confused on this issue. Answer: Since there are bundling edits for the codes...
June 6, 2019 Question: A pathology report came back from a skin biopsy stating “compound dysplastic lesion with severe atypia. Re-excision recommended.” Should the diagnosis code be D48.5 for lesion of uncertain behavior of the skin be assigned, or a benign code since it does not state it is malignant? Answer: Since the pathology notes...
May 23, 2019 Question: What is the correct code for a tangential biopsy of the antihelical fold? I was going to bill 11102, but I was told that there are different codes in other sections of CPT for some biopsies. Answer: The correct code would be 69100, Biopsy external ear. As a bonus, this correct...
May 9, 2019 Question: If I remove 3 small skin tags (less than 0.5cm) by shave technique from a patient’s neck, can I bill 11305 with three units due to the technique? Answer: No. According to CPT, the skin tag removal codes 11200-11201 are for removal of skin tags “by scissoring or any sharp method,...
April 25, 2019 Question: My doctor did two adjacent tissue transfers, one on the abdomen and one on the each leg of the patient. He wants to bill 14020 with modifier 50, but I don’t think that is correct. Help. Answer: CPT code 14020 has an indicator of “0” for bilateral procedures, which means that...
April 11, 2019 Question: I had a patient that came in for Mohs surgery for a BCC and I noticed another suspicious site on the patient’s scalp. I did a tangential biopsy and pathology, which turned out to be an AK. Can I bill for both the biopsy and pathology that I did of the...
March 28, 2019 Question: One of my colleagues told me that she was doing e-consults with other physicians for Medicare and getting paid. Is this a billable service? Answer: Yes! Medicare has added CPT codes 99446-99452 for interprofessional/ telephone/internet/electronic health record (EHR) consultations to the fee schedule, so they are now payable services. These are...
March 14, 2019 Question: Since the skin biopsy codes changed, I would like to ask if you know of any changes to the CPT codes for optical biopsies of the skin. Some of these codes include: 96931 First lesion – cellular and sub-cellular imaging of skin; combined image acquisition and interpretation and report, 96932 image acquisition only,...
February 28, 2019 Question: What happened to the skin biopsy codes? Answer: CPT deleted CPT codes 11100 and 11101 and replaced them with six new codes: 11104 Punch biopsy of skin (including simple closure, when performed); single lesion (NF Allowable $143.48) +11105 each separate/additional lesion (List separately in addition to code for primary procedure)...
