09/25/2004    Richard Frost, DPM

Heel Fat Pad Biopsy Coding

Query: Heel Fat Pad Biopsy Coding

I would like to know the proper CPT coding for a
heel fat pad biopsy. I get referrals from a
neurologist to do fat pad biopsies to evaluate
for amyloidosis (Congo red stains) as an
etiology for peripheral neuropathy. The biopsy
is obtained via punch biopsy, and the fat
underneath the dermis is sent for exam. Would
this be considered CPT 11100 (biopsy of skin,
subcutaneous tissue), or could this be billed as
CPT 27613 (biopsy, soft tissue of leg or ankle
area)? Or is there a more specific, appropriate
code?

Richard Frost, DPM
Spokane, WA

Codingline Response: CPT 11100 is defined as
a "biopsy of skin, subcutaneous tissue and/or
mucous membrane (including simple closure)".

CPT 27613 is defined as "biopsy, soft tissue of
leg or ankle area; superficial".

It would appear code describes your
subcutaneous "punch biopsy" procedure, and now
you have determine, all things being equal,
which code is to your advantage to bill.

CPT 11100 while having a "0" day Medicare global
period is valued at 2-3 times less than CPT
27613 which has been assigned a 10 day Medicare
global period. If you normally see your post-
punch biopsy patients for follow-up within 10
days of the procedure, it may be worth your
while to bill CPT 11100, and charge for the post
surgical evaluation (with management). If the
patient will not be seen for 11-14 days post
biopsy, then CPT 27613 should better fit your
needs.

The above assumes that the biopsies are being
performed for medically necessary reasons, and
not part of a clinical study (paid by another
source) or other investigations.

Denise Paige, CPC
Long Beach, CA

Other messages in this thread:

---

09/27/2004    Bryan C. Markinson, DPM, Mel Goldenberg, DPM

Heel Fat Pad Biopsy Coding (Richard Frost, DPM)

RE: Heel Fat Pad Biopsy Coding (Richard Frost,
DPM)
From: Bryan C. Markinson, DPM, Mel Goldenberg,
DPM

Dr. Frost asked for the correct coding for a
punch biopsy of the heel area that includes the
subcutaneous fat. He asked which code 11100
(biopsy of skin, subcutaneous tissue), or code
27613 (biopsy, soft tissue of leg or ankle area)
is the correct code. The answer given by Denise
Paige was that either code was appropriate. I
believe this to be incorrect. Firstly, by the
description alone, 27613 is not proper as the
heel is not the leg or ankle area. I also
believe that if you ask the CPT consultants,
they will state that the "soft tissue" referred
to in the descriptor of code 27613 does not
include skin. Anatomically and histologically
though, code 11100 appears best for the
procedure outlined.
Can we get more clarification on this?

Bryan C. Markinson, DPM
New York, NY

I fail to see how CPT 27613 biopsy, soft tissue
of leg or ankle area could possibly be correct
if you are doing a biopsy of the heel. And, the
plantar surface at that. Doesn't "leg or ankle"
have any meaning?

Mel Goldenberg, D.P.M.
New York, NY