New Skin Biopsy Codes #PACPearls

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By Dr. Mark Kaufmann

On July 12, 2018 CMS published their proposed rule on the Medicare Physician Fee Schedule. This 1,440 page document is filled with some very broad ranging proposals.

These proposals include a blended E/M code system (one E/M code to replace 99202-99205, and 99212-99215), a 50% cut in E/Ms billed with a modifier -25, and another call for comments on whether global period visits are happening, just to name a few.

While many of these changes could have wide ranging effects on all of our practices, today’s pearl will deal with the one change that will definitely happen on January 1, 2019- 6 new skin biopsy codes to replace the 2 that we are used to using.
  1. Current CPT codes 11100 and 11101 will be deleted from the CPT book AND will be denied payment if used on or after January 1, 2019.

  2. Replacing them will be 6 NEW codes- 3 base codes and 3 “additional biopsy" codes.

  3. The three new categories will be “Tangential Biopsy of Skin" (think Shave Biopsy), one for “Punch Biopsy of skin,” and one for “Incisional Biopsy of Skin (think wedge biopsy).”

  4. If you do more than one biopsy, using more than one modality, you would use the base code for the more valuable service, and the “additional biopsy” code from the lower value service. (eg if you do a punch and a shave, you would code the punch base code, and the tangential add-on code).
The following tables will help you to better understand the proposed work RVUs and payment for these new services:



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