What are examples of frequently used site-specific skin biopsy codes?

Answer: Here’s a list of some commonly used biopsy codes and their Medicare Physician Fee Schedule rates when performed in a nonfacility setting. These rates are the national rates before applying geographic price adjustments. All the site-specific codes have higher rates than generic codes 11100 ($104.40) and +11101 ($32.89), which you use only when no more specific code is available.

• 11755 — Biopsy of nail unit (e.g., plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure) [$134.80]
• 30100 — Biopsy, intranasal[$144.45]
• 40490 — Biopsy of lip[$131.58]
• 40808 — Biopsy, vestibule of mouth[$194.51]
• 54100 — Biopsy of penis; (separate procedure)[$201.30]
• 67810 — Incisional biopsy of eyelid skin including lid margin[$173.05].

Important: Before choosing a biopsy code, remember that you first must determine whether the dermatologist performed a biopsy or excision. Proper identification will ensure your coding and reimbursement are correct. For instance, while 67810 brings in $173 for eyelid biopsy, the rate is $523.09 for excision code 11646 (Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cm).