Excision versus Biopsy

Excision versus Biopsy

October 3, 2019

Question:
Does this code description require a scalpel? If you do a punch excision – margins are clear. Can that be billed as excision ? Does excision require a scalpel? A patient got a bill and she is a nurse and claims it should be a punch biopsy.   

Answer:
The excision codes do not state that a scalpel must be used to perform the procedure, only that a full-thickness excision is required. The reporting of the CPT code(s) will depend on the intent of the procedure. If the intent of the procedure is to establish a diagnosis and there is no attention to margins when the punch is performed, it would support a biopsy. If the intent of the procedure is to excise the lesion in its entirety and there is attention paid to margins, then it would support an excision. The tool used to perform these procedures does not make a difference.

*This response is based on the best information available as of 10/03/19.

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