• My Account
    • Login
  • Contact Us

CodingIntel

Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

  • Join Today
  • What is CodingIntel
    • About
    • Become a Member
    • FAQ
  • Pricing
  • Free Resources
    • Overview
    • Blog
    • Everyday Coding Q&A
    • Newsletter
    • Can I get paid
  • Coding Library
    • Coding Guides
    • Quick Reference Sheets
    • E/M Services
    • How Physician Services Are Paid
    • Prevention & Screening
    • Care Management & Remote Monitoring
    • Surgery, Modifiers & Global
    • Diagnosis Coding
    • New & Newsworthy
    • Speciality
    • Practice Management
    • E/M Rules Archive
  • Webinars

March 25, 2023

Coding for biopsy | Should we wait for a pathology report?

Print Friendly, PDF & Email

Question:

Should we always wait for the pathology report before submitting a code for a biopsy?

Answer:

Sometimes.

Wait for the pathology report only for excision of benign or malignant lesions, which are coded based on the pathology report. These codes describe excision of benign lesions in the code series 11400 to 11446 and excision of malignant lesions in the code series 11600 to 11646.

The claim for any other type of biopsy may be submitted on the date the service is performed.

This includes:

  • shave biopsies
  • breast biopsies
  • fine needle aspirations (new codes in 2019)
  • punch, incisional, and tangential biopsies (new codes in 2019)
  • and any other biopsies except those listed above.

It is only necessary to wait for the pathology report for the excision of lesions, listed above, because the CPT® code is dependent on the diagnosis.

In Principles of CPT® Coding there are two other situations described in which it is not necessary to wait for the pathology report.

The first is if the lesion being excised is clearly benign, it is permissible to submit the claim using the excision of benign lesion codes.

And second, for a re-excision of a malignant lesion, report the CPT® codes for excision of a malignant lesion, even if the margins are negative. In that case, if it is a re-excision of a malignant lesion, the claim can be submitted at the time services performed without waiting for the pathology report.

 

View all Everyday Coding Q&A’s


Watch Betsy’s 60 minute on-demand webinar “Coding Skin Procedures” for a review of coding common skin procedures and correct use of modifiers with multiple procedures. Webinars are free for members. Not a member? Find out how you can watch too!


Get more tips and coding insights from coding expert Betsy Nicoletti.

Subscribe and receive our FREE monthly newsletter and Everyday Coding Q&A.

Sign up

We will never share your email address. Unsubscribe anytime.

Relevant Search Terms: coding for biopsy

Last revised August 18, 2021 - Betsy Nicoletti
Tags: general surgery_diagnosis coding, minor procedures

CPT®️️ is a registered trademark of the American Medical Association. Copyright American Medical Association. All rights reserved.

2023 E/M reference sheets

These handy quick reference sheets included at-a-glance MDM requirements for office, hospital, nursing home and home and residence services. And, a bonus sheet with typical time for those code sets. Sign up for Betsy’s monthly newsletter to download these reference sheets and share them with your practitioners.

Sign Up Now

2023 E/M guidelines for hospital, nursing facility, home and residence services | Webinar

Effective January 1, 2023, the AMA has revised the definitions and guidelines for hospital and other E/M services, including ED visits, nursing facility services, home services, and domiciliary care codes. Also, coding for prolonged care services gets another overhaul with revised codes and guidelines. Watch this webinar about all these changes.

Watch it now

Latest Intel

Coding for hospital services | Webinar

Coding for hospital services April 20, 2023 … Read More...

CMS Split/Shared Services Rules | Reference Sheet

Download Reference Sheet Split/shared services … Read More...

Chronic Care Management | Reference Sheet

This quick reference sheet includes clinical staff … Read More...

Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse | HCPCS Code G0442

The  US Preventive Services Task Force (USPSTF) … Read More...

Browse By Categories

Browse Content

  • Articles
  • Coding Guides
  • Everyday Coding Q&A
  • Videos
  • Can I Get Paid to
  • Blog
  • Webinars

Tags

behavioral health_cpt codes behavioral health_E/M services care management CMS updates Code sets and reimbursement compliance issues CPT codes for preventive services CPT updates critical care services dermatology_essential resource dermatology_procedures E/M frequency data E/M medical decision making E/M overview E/M reference sheets FQHC general surgery_diagnosis coding general surgery_E/M services general surgery_modifiers general surgery_procedures global surgery issues HCC diagnosis coding hospital inpatient/observation ICD-10 coding level of service_history level of service_MDM level of service_time medicare incident-to and shared services minor procedures modifiers newborn care office and other E/M Preventive and problem visits preventive services for medicare primary care_diagnosis coding primary care_E/M services primary care_essential resource primary care_modifiers primary care_other E/M services primary care_preventive services primary care_procedures remote physiologic monitoring screening and counseling for behavioral conditions teaching physician rules telehealth

All content on CodingIntel is copyright protected. Any resource shared within the permissions granted here may not be altered in any way, and should retain all copyright information and logos.

  • What is CodingIntel
  • FAQs
  • Terms of Use
  • Privacy Policy
  • Contact

Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

Copyright © 2023, CodingIntel
Privacy Policy