Coding for Biopsies, Shave Removals, and Excisions
Biopsies, shave removals, and excisions are basic procedures that dermatologists routinely perform to diagnose disease, relieve symptoms, and to treat cancers. From a coding perspective, these 3 procedures are characterized differently based on the intent and depth of the removal. Specialized biopsy codes are available for certain anatomic sites, and soft-tissue excision codes can be used in lieu of standard skin excision codes for tumors that are confined to the subcutis and below.
Practice Points
- Biopsies are coded when there is an independent procedure to remove skin for histologic analysis to help establish a definitive histologic diagnosis.
- Coding for shave removals and excisions requires the intent to remove the entire lesion.
- Unlike shave removals, excisions can be coded only if the lesion is removed to the level of the subcutaneous fat.
- When available, site-specific biopsy or soft tissue excision codes may better describe a procedure than standard biopsy or excision codes.
Final Thoughts
In summary, biopsies, shave removals, and excisions are different procedures and therefore should be coded differently. Although the distinction between biopsies and shave removals is ill defined, remember that biopsies are intended to establish a diagnosis and shave removals are intended to remove the entire lesion. By definition, excisions must include margins and proceed through the dermis to the subcutis. In particular circumstances, site-specific biopsy codes may be appropriate and can be used to code for lipoma excisions.
