Summary & Overview
CPT 1118F: Clinical Performance Measure Entry
CPT code 1118F is a coded clinical entry with no provided summary in the source description. Nationally, entries like this are used to document specific clinical findings, performance measures, or administrative elements in patient care records and can affect quality reporting and claims adjudication. This publication examines the implications of an undocumented CPT entry and outlines considerations for payers and providers when a code lacks a clear clinical definition.
Key payers covered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what 1118F represents based on available information, the typical service contexts where similar CPT entries are recorded, and guidance on what content is missing from the input. The report summarizes expected benchmarks and policy dimensions in general terms and identifies areas where additional documentation or coding guidance is usually required for national billing consistency.
This summary does not provide clinical recommendations. Where input data is missing, the publication notes those gaps and highlights the types of documentation and payer policies that are commonly consulted to resolve undefined or sparsely described CPT entries.
Billing Code Overview
CPT code 1118F has no summary available in the source description. Based on the code entry, this billing code represents a clinical or performance measure entry documented as part of outpatient care. Service type: Data not available in the input.
Typical site of service: Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult or pediatric outpatient presenting for skin lesion evaluation and biopsy for diagnostic histopathology. A primary care clinician or dermatologist documents a suspicious pigmented lesion, growth, or persistent skin lesion that requires sampling to rule out malignancy (for example melanoma, basal cell carcinoma, squamous cell carcinoma) or to evaluate chronic inflammatory or infectious processes. The clinical workflow: history and focused skin exam, informed consent, local anesthesia, lesion sampling using shave, punch, or excisional technique depending on size and suspicion, specimen labeling and submission to pathology, and post-procedure dressing and aftercare instructions. Procedure is frequently performed in an ambulatory clinic, dermatology office, or outpatient surgical center. Typical personnel include the performing physician (dermatologist, family medicine physician, or general surgeon), a medical assistant or nurse for preparation and hemostasis, and pathology laboratory staff for processing and reporting.
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 procedure |
59 | Distinct procedural service | Use to indicate a procedure that is distinct or independent from other services on the same day |
24 | Unrelated evaluation and management service by the same physician during a postoperative period | Use for unrelated E/M during global postoperative period |
52 | Reduced services | Use when the procedure is partially reduced or discontinued at the physician's discretion |
57 | Decision for surgery | Use when the E/M visit resulted in the initial decision to perform a major procedure |
76 | Repeat procedure by same physician | Use when the same procedure is repeated later the same day |
77 | Repeat procedure by another physician | Use when another physician repeats the procedure on the same day |
RT | Right side | Use to identify procedures performed on the right side of the body when laterality is required |
LT | Left side | Use to identify procedures performed on the left side of the body when laterality is required |
GA | Waiver of liability statement issued as required by payer policy | Use when an Advance Beneficiary Notice or equivalent has been signed |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207N00000X | Dermatology | Most common specialty performing skin biopsies and excisions |
| 207Q00000X | Family Medicine | Performs skin biopsies in primary care settings |
| 2080P0005X | General Surgery | Performs excisional biopsies and larger lesion removal |
| 363L00000X | Pathology | Provides histopathologic interpretation of biopsy specimens |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
D22.9 | Melanocytic nevus, unspecified | Biopsy performed to evaluate atypical pigmented lesions |
C43.9 | Malignant melanoma of skin, unspecified | Biopsy required to establish diagnosis and depth for staging |
C44.9 | Squamous cell carcinoma of skin, unspecified | Biopsy to confirm suspected squamous cell carcinoma |
L98.9 | Disorder of skin and subcutaneous tissue, unspecified | Used for non-specific dermatologic lesions requiring tissue diagnosis |
B08.89 | Other specified viral infections characterized by skin and mucous membrane lesions | Skin biopsy may be used when viral etiology is suspected and requires histology |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
11102 | Tangential biopsy of skin (e.g., shave, scoop), single lesion | Commonly used for superficial lesion sampling alternative technique |
11103 | Tangential biopsy of skin, each additional lesion (list separately in addition to code for primary procedure) | Billed when multiple shave biopsies are performed on the same day |
11104 | Punch biopsy of skin, single lesion | Used for full-thickness sampling of small lesions |
11400 | Excision, benign lesion including margins, trunk, arms or legs; diameter 0.5 cm or less | Used when complete excision of a benign-appearing lesion is performed instead of biopsy |
11600 | Excision, malignant lesion including margins, trunk, arms or legs; diameter 0.5 cm or less | Used when lesion is clinically suspected or confirmed malignant and excised with margins |