When and How to Report Biopsy Separately  

Category: Coding

Typically, you may not separately report a biopsy performed with an excision, destruction, or other removal procedure. Medicare specifies two exceptions to this rule, however, as described in Chapter 1 of the National Correct Coding Initiative (NCCI), "General Correct Coding Policies for National Correct Coding Initiative Policy Manual for Medicare Services."

Exception 1.

"If the biopsy is performed on a separate lesion, it is separately reportable. This situation may be reported with anatomic modifiers or modifier 59."
The CPT® codebook mirrors this advice, stating, "&biopses are not considered components of other procedures when performed on different lesions or different sites on the same date, and are to be reported separately."

For example, if the provider biopsies a lesion on the right breast, and excises a lesion on the left breast, th...