Summary & Overview
CPT 11104: Punch Biopsy of Skin Lesion, Full-Thickness Circular Sample
CPT code 11104 denotes a punch biopsy of a skin lesion, a common minor surgical procedure that yields a full-thickness circular specimen for histopathologic diagnosis. This code is nationally relevant because punch biopsies are a frontline diagnostic tool in dermatology and primary care for evaluating inflammatory conditions, suspicious neoplasms, and other deeper skin abnormalities. Accurate coding of biopsy procedures affects clinical documentation, pathology workflow, and reimbursement for ambulatory surgical services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise overview of clinical context for punch biopsies, typical sites of service, and how CPT code 11104 is positioned relative to related procedure codes for additional lesions or closures. The publication highlights common coding relationships and considerations that influence billing workflows and claims adjudication. It also outlines relevant ICD-10 diagnosis groupings commonly associated with biopsy indications, and references closely related CPT code 11105 for additional lesions. The content serves clinicians, coding professionals, and practice managers seeking a clear, national-level summary of what CPT code 11104 represents, why it matters in outpatient dermatologic care, and where it fits within routine procedural coding.
Billing Code Overview
CPT code 11104 describes a punch biopsy of a skin lesion performed with a sharp hollow instrument to obtain a full-thickness circular tissue sample. This procedure is typically used for deeper, circular skin lesions when a sample of epidermis and dermis is required for diagnostic evaluation.
Service type: Skin biopsy (punch technique)
Typical site of service: Outpatient clinic or dermatology office, including primary care or specialty dermatology settings where minor surgical dermatologic procedures are performed.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient presents to a dermatology clinic with a 6-mm raised, erythematous papule on the forearm that has changed in color and occasionally bleeds. The dermatologist performs a focused skin exam, documents lesion size, morphology, and clinical concern for possible neoplasm, and obtains informed consent. The provider prepares the site using antiseptic, administers local anesthesia, and performs a 11104 punch biopsy to obtain a full-thickness circular specimen down into subcutaneous fat for histopathologic diagnosis. The specimen is placed in formalin, labeled, and sent with a requisition to dermatopathology. The patient receives wound care instructions and a follow-up plan for pathology results and possible further treatment depending on diagnosis (benign lesion, premalignant, or malignant). Typical workflow participants include a Dermatology Physician (207N00000X) or Family Medicine Physician (207Q00000X) performing the procedure, and a Dermatopathology Physician (208D00000X) interpreting the biopsy specimen. Typical site of service is an outpatient dermatology clinic, ambulatory surgery center, or office-based procedure room.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 |