Summary & Overview
CPT 1091F: Performance Measure (No Summary Provided)
CPT code 1091F is a Current Procedural Terminology entry with no summary provided in source materials. As a CPT code, it represents a defined clinical or performance-related item used in billing and reporting. Nationally, accurate labeling of CPT codes matters for claims processing, quality measurement, and consistent clinical documentation across payers.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise description of what the code denotes, the typical service and site assumptions when source details are missing, and guidance on where missing data is noted.
This publication details the code's representation, identifies gaps in source documentation, and outlines the types of benchmarks and policy or clinical context readers can expect in a fuller analysis when additional data are available. It highlights standard elements that would normally accompany a CPT code brief — such as service line, site of service, related diagnoses, and common modifiers — while clearly marking fields that are not available in the input.
Billing Code Overview
CPT code 1091F is currently listed without a summary in the source description. Based on the available information, the code represents a specific clinical or administrative performance measure within the CPT code set.
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Service type: Data not available in the input.
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Typical site of service: Data not available in the input.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an outpatient dermatology or general surgery clinic with a suspicious skin lesion (e.g., enlarging pigmented lesion, non-healing ulcer, or symptomatic papule) requiring a targeted skin biopsy for histopathologic diagnosis. The workflow includes a focused history and exam, informed consent, local anesthetic administration, lesion preparation and aseptic technique, performance of a shave, punch, or excisional biopsy depending on lesion characteristics, specimen labeling and placement in formalin, and completion of procedure notes with wound care instructions. The specimen is sent to pathology for definitive diagnosis; results drive subsequent management such as wide local excision, dermatology follow-up, or oncology referral.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when a distinct E/M visit is performed on the same day as the biopsy and is medically necessary and documented separately from the procedure. |
| 57 | Decision for surgery | Use when the biopsy is performed as the initial decision that leads to a surgical inpatient admission (rare for outpatient skin biopsies).
| 59 | Distinct procedural service | Use when another procedure performed on the same day is distinct and not typically reported together; supports separate billing when documentation shows separate anatomic site or separate session.