Summary & Overview
CPT 11104: Punch Biopsy of Skin, Single Lesion
CPT code 11104 represents a punch biopsy of the skin for a single lesion, a procedure frequently performed to diagnose skin disorders and neoplasms. This code is widely recognized across the United States and is integral to dermatology, family medicine, and dermatopathology practices. The procedure is typically conducted in an office setting, making it accessible for patients requiring skin evaluations.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare, provide coverage for services billed under CPT code 11104. The publication offers a comprehensive overview of payer policies, clinical benchmarks, and billing practices relevant to this code. Readers will gain insights into the clinical context of punch biopsies, common billing modifiers such as 59 and 51, and associated provider taxonomies. Additionally, the summary includes information on related CPT codes and ICD-10 diagnoses commonly linked to punch biopsy procedures.
This article is designed to inform healthcare professionals, billing specialists, and policy analysts about the national landscape for CPT code 11104, including payer coverage, clinical indications, and procedural details. It serves as a resource for understanding the role of punch biopsies in skin disease management and the nuances of medical billing for this essential service.
CPT Code Overview
CPT code 11104 is used to report a punch biopsy of skin for a single lesion, including simple closure when performed. This procedure is classified under surgery and biopsy procedures on the skin and is commonly performed in an office setting (Place of Service 11). Punch biopsies are essential for diagnosing a variety of skin conditions and are a routine part of dermatologic and primary care practice.
Clinical & Coding Specifications
Clinical Context
A patient presents to a dermatology or family medicine office with a suspicious skin lesion. The provider determines that a punch biopsy is necessary to obtain a tissue sample for diagnostic evaluation. The procedure involves using a circular blade to remove a small core of skin from the single lesion, followed by simple closure if needed. This workflow is typical for evaluating lesions of uncertain behavior, possible malignancy, or other skin disorders. The service is performed in an office setting (Place of Service 11) by providers such as dermatologists, family medicine physicians, or dermatopathologists.
Coding Specifications
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Modifier
59: Distinct Procedural Service. Used when a punch biopsy is performed on a different anatomical site or during a separate session from other procedures, indicating that the service is separate and distinct. -
Modifier
51: Multiple Procedures. Applied when multiple procedures, including punch biopsies, are performed during the same encounter. This modifier indicates that more than one procedure was performed.
| Provider Taxonomy Code | Specialty Name |
|---|---|
207N00000X |