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An incisional biopsy of the skin, as described by CPT® Code 11107, is a surgical procedure that involves the removal of a small wedge-shaped section of tissue from a skin lesion. This procedure is primarily performed to obtain a sample for pathological examination, allowing healthcare professionals to identify the cellular composition and type of cells present within the lesion. Incisional biopsies are particularly indicated for larger lesions where a complete excision may not be feasible or when it is necessary to determine the most appropriate treatment options while ensuring a satisfactory cosmetic outcome. The procedure begins with the careful marking of the biopsy area, followed by the administration of a local anesthetic to minimize discomfort. A scalpel is then utilized to make an incision along the marked lines, extending down to the subcutaneous tissue to create a small island of skin and tissue. This island is subsequently grasped with forceps and excised, ensuring that the specimen is collected for further pathological analysis. After the specimen is removed, the wound is assessed for any bleeding, and the edges of the skin are approximated to facilitate closure. The procedure may involve the use of absorbable sutures in the subcutaneous layer to reduce tension and promote healing, followed by the closure of the skin with either sutures or staples. It is important to note that CPT® Code 11107 is specifically used to report the incisional biopsy of each separate or additional lesion, distinguishing it from CPT® Code 11106, which pertains to a single skin lesion biopsy.
© Copyright 2025 Coding Ahead. All rights reserved.
The incisional biopsy of the skin, as indicated by CPT® Code 11107, is performed under specific circumstances where a detailed examination of a lesion is necessary. The following conditions may warrant this procedure:
The procedure for an incisional biopsy of the skin involves several critical steps to ensure proper execution and patient safety. The following outlines the procedural steps as described:
After the incisional biopsy is completed, post-procedure care is essential for optimal recovery. The patient should be monitored for any signs of bleeding or infection at the biopsy site. Instructions regarding wound care, including keeping the area clean and dry, should be provided. Patients may also be advised on pain management strategies, which could include over-the-counter pain relievers. Follow-up appointments may be necessary to assess the healing process and to discuss the results of the pathological examination. It is important for patients to be aware of any signs of complications, such as increased redness, swelling, or discharge from the wound, and to seek medical attention if these occur.
| Short Descr | INCAL BX SKN EA SEP/ADDL | Medium Descr | INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION | Long Descr | Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); each separate/additional lesion (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | none | MUE | 2 |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 11106 | MPFS Status: Active Code APC T ASC P3 Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | GC | This service has been performed in part by a resident under the direction of a teaching physician | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | E1 | Upper left, eyelid | E2 | Lower left, eyelid | E3 | Upper right, eyelid | E4 | Lower right, eyelid | F2 | Left hand, third digit | GA | Waiver of liability statement issued as required by payer policy, individual case | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | LT | Left side (used to identify procedures performed on the left side of the body) | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) | SG | Ambulatory surgical center (asc) facility service | T1 | Left foot, second digit | T2 | Left foot, third digit | T5 | Right foot, great toe | T7 | Right foot, third digit | TA | Left foot, great toe | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2019-01-01 | Added | Added |
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