BC Advantage - 2015 Issue 10

When and How to Report Biopsy Separately

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...

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