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Biopsies are used to obtain a sample of your tissue or cells for diagnostic histopathologic examination performed independently or unrelated/distinct from other procedures/services. The removal of tissue or cells for analysis is called a biopsy. A skin biopsy is a procedure in which a physician cuts and removes small samples of skin or cells from the surface of your body to get it tested. The sample obtained from a skin biopsy is further examined to diagnose certain skin conditions such as skin tumors, infections and other types of growth or skin conditions. A biopsy of a lesion of the skin can help physicians report the difference between a skin cancer and a benign or noncancerous lesion. The skin sample obtained during a biopsy is further sent for laboratory analysis under a microscope.Dermatology medical coding involves several difficult aspects for coders to memorize unique termsrelated to sizing wounds and lesions. As skin procedure codes take into account the type of removal, the size and location of the lesion (such as length, depth, width, and circumference), the provider’s intent and pathologic results, documenting the service and selecting the right medical codes can be confusing. Outsourcing the task to a reliable and experienced medical billing and coding company is a feasible strategy that helps physicians simplify their documentation process. Coders must be familiar with terminology related to benign and malignant masses along with actions such as shaving, destruction, and performing biopsies.

Why Is a Skin Lesion Biopsy Done?

Generally, a skin biopsy is performed to determine the cause of a growth, sore or rash and could include –

• Skin cancer including basal cell carcinoma, squamous cell carcinoma and melanoma
• Rashes or blistering skin conditions
• Pre-cancerous cells
• Non-cancerous growths
• Chronic bacterial or fungal skin infection
• Changing moles
• Actinic keratosis
• Warts

The potential risk factors associated with this procedure include – excessive bleeding from the biopsy site, pain, skin infections, local reaction to the anesthetic, scarring and other healing problems.

Types of Skin Biopsies
There are four main types of skin biopsies which include –

• Shave biopsy – Physicians will remove only a small section of the top layers of skin (epidermis and a portion of the dermis) using a special razor blade or scalpel.
• Punch biopsy – Physicians use a circular tool to remove a small section of skin including deeper layers (epidermis, dermis and superficial fat).
• Excisional biopsy – This type is used to remove the entire lesion/abnormal skin, including a portion of normal skin down to or through the fatty layer of skin.
• Incisional biopsy – This is used to remove a small part of a larger lesion.

After the biopsy, the wound will be covered with gauze and other bandaging. Patients will be able to go home once the sample has been taken.

Undergoing Skin Biopsy – Preparations Required

Generally performed in the doctor’s office, patients undergoing skin biopsy will be asked to change into a hospital gown so that the area of suspect skin can be more easily seen and removed. Before undergoing the procedure, patients must disclose information about – current medicines consumed (including over-the-counter drugs, street drugs, or herbal or nutritional supplements), any allergies/reactions to medications (especially to local anesthetics, such as lidocaine or novocaine, or to iodine cleaning solutions, such as Betadine), pregnancy and bleeding problems if any.
The physician will first cleanse the biopsy site (with a sterile soap solution) and then numb the skin by using a local anesthetic (pain-relieving) injection, usually lidocaine. Patients will experience a brief prick and stinging sensation as and when the medicine is injected. After the skin is numb, the physicianwill perform the biopsy and the tissue will be removed. The removed portion of tissue will be sent to the laboratory for analysis by a pathologist. After the procedure, the wound will be covered with gauze and other bandaging. A skin biopsy typically takes about 15-20 minutes, including the preparation time, dressing the wound and instructions for at-home care.

CPT Codes for Skin Biopsies

Dermatology medical codinginvolves the use of specific CPT codes to document different types of skin biopsies. The CPT codes for skin biopsies include –

For the first biopsy, submit code 11100 – Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion). For each separate biopsy after the first one, use the add-on code 11101 – Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed separate procedure; each separate/additional lesion [List separately in addition to the code for primary procedure].

For instance, if three lesions are biopsied, codes 11100, 11101 and 11101 should be submitted.  If skin biopsy is performed more than the maximum number of times, it is important to submit supporting documentation to avoid denials. If the removal is simply for diagnosis, the procedure is coded as a biopsy. If the entire lesion is removed, the excision codes should be used.

The new CPT codes that range from 11102 – 11107 are reported on the basis of method of removal, which offers greater specificity. The new CPT codes are as follows –

• 11102 – Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette) single lesion
• +11103 – Each separate/additional lesion (List separately in addition to code for primary procedure)
• 11104 – Punch biopsy of skin (including simple closure, when performed) single lesion
• +11105 – Each separate/additional lesion (List separately in addition to code for primary procedure
• 11106 – Incisional biopsy of skin (including simple closure, when performed) single lesion
• +11107 – Each separate/additional lesion (List separately in addition to code for primary procedure

Prior to the above new CPT codes, biopsies were reported with CPT code 11100 for the first lesion and 11101 for each additional lesion biopsied regardless of method of removal. However, the new biopsy codes are reported based on method of removal including –

• Tangential biopsy (Codes – 11102 and 11103)

Tangential biopsy includes removal via shave, scoop, saucerization or curette. The procedure is performed with a sharp blade like a flexible biopsy blade, obliquely oriented scalpel or curette.  A sample of epidermal tissues is removed with or without portions of the underlying dermis.  This type of biopsy does not involve the full thickness of the dermis.  When the full thickness of the dermis is involved, the procedure is reported using the codes – 11300-11313 (removal of epidermal or dermal lesions).

• Punch biopsy (Codes -11104 and 11105)

Performed using a punch tool, the purpose of this biopsy is to remove a sample of a cutaneous lesion for a diagnostic pathologic examination.  Simple closure is included and cannot be billed separately.

• Incisional biopsy (Codes -11106 and 11107)

An incisional biopsy requires a sharp blade (not a punch tool) to remove a full-thickness sample of tissue via a vertical incision or wedge, penetrating deep into the dermis, into the subcutaneous space. An incisional biopsy may sample subcutaneous fat.  When the entire lesion is excised, it is important report the excision codes – 11400-11646 (depending on type of lesion – benign or malignant).

• Multiple Biopsies

If more than one biopsy is performed on the same date, report only one primary biopsy code.  When more than one biopsy is performed using the same technique, the appropriate primary biopsy code is reported for the first biopsy and the add-on code is reported for each additional lesion.

Recovery after the Procedure

Once the skin biopsy is complete, patients may experience some soreness around the biopsied site for a few days. Physicians will either put a bandage or stitches (in some cases) over the biopsy site. In most cases, physicians may instruct patients to keep the bandage over the biopsy site until the next day.  They may be advised to change the bandage daily, wash the wound and apply antibacterial ointment. Tylenol is usually sufficient to relieve discomfort. However, patients who have stitches around the biopsy site need to keep the area as clean and dry as possible. Healing of the wound can take several weeks, but is usually complete within two months. Wounds on the legs and feet tend to heal slower than those on other areas of the body.
Medical billing and coding can be complex and requires knowledge regarding appropriate coding, modifiers and payer-specific medical billing for correct and on-time reimbursement. With all the complexities, the support of an experienced medical coding serviceprovider could be useful to report skin biopsy procedures correctly for optimal reimbursement. Professional coders in reliable medical billing and coding companies can ensure accurate reporting of diagnostic and procedure details.

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The knee is a fragile and sensitive joint which plays a vital role in the body’s stability and motion. The knee is made up of many structures and these can be severely injured by a traumatic event or disease. Injuries generally occur due to twisting or bending force applied to the knee or a direct blow suffered while playing sports, or by a sudden fall or accident. In addition to sudden injury, repetitive overuse and underlying medical conditions like osteoporosis can cause knee pain. There are different types of knee injuries all of which involve various symptoms including pain, swelling, and stiffness. Injury to the knee can cause instability and become debilitating if not treated quickly. Fortunately, effective nonsurgical knee injury treatment is available in established pain management and rehabilitation centers in Brooklyn, NYC.

Common Injuries of the Knee — Symptoms and Causes

Injuries to the knee are mainly defined by the affected anatomy of the knee and the mechanism that caused the injury. Let’s take a look at some common knee injuries –

• Sprains – A sprain is an injury to the ligaments that hold the knee together. Sprains are graded by the amount of stretching or tearing of the ligament fibers and how much instability it causes. Ligament tears include – injuries to anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), lateral collateral ligament (LCL) and medial collateral ligament (MCL). ACL injuries occur as a result of a twisting or pivoting movement. PCL injuries are the result of a powerful force such as a football player falling on a knee that is bent. The LCL runs along the outside of the knee joint and stabilizes the knee so that the bones do not slide from side to side. A common injury among athletes, MCL sprain occurs due to a blow to the outside of the knee, which forces the knee inward.
• Strains – Strains occur when the tendons or muscles surrounding the knee are stretched, usually due to hyperflexion or hyperextension of the knee. Strains can cause pain outside the joint as well as dysfunction of the normal range of motion of the knee.
• Tendinitis – Tendinitis refers to inflammation or irritation of a tendon (the thick fibrous cords that attach muscle to bone) that connects the kneecap to the shinbone. Also known as jumper’s knee, tendonitis is common among athletes who frequently jump. However, any physically active person can be at risk of developing this condition.
• Bursitis – This is a painful condition that affects the bursae – small, fluid-filled sacs that cushion the bones, tendons and muscles near your joints. Bursitis occurs when bursae swells and become inflamed with overuse or repeated pressure from kneeling. Most cases of bursitis respond well to self-care measures. However, in some instances, antibiotics or aspiration (a procedure that uses a needle to withdraw excess fluid) may be required.
• Runner’s knee – Patellofemoral pain syndrome or runner’s knee is one of the most common causes of knee pain in young athletes. It is caused by overuse of the patellofemoral joint (the joint between the kneecap (patella) and thighbone) — causing pain in the front of the knee.
• Meniscal tears – One of the most frequently occurring cartilage injuries of the knee, meniscal tears generally occur when the knee twists or pivots. Symptoms include pain, stiffness, swelling, locking, and decreased range of motion. This type of knee injury is common in contact sports like football as well as noncontact sports requiring jumping and cutting such as volleyball and soccer.
• Fractures and dislocations – Knee fractures are usually the result of trauma such as falling directly on the knee, repetitive stress injuries, osteoporosis and tumors. Dislocation is the displacement of a joint from its normal position, which is usually caused by a blow, fall or other trauma. Symptoms include loss of motion, swelling and pain and sometimes, a visibly out of place joint.
• Cartilage injuries – Cartilage, the tough, flexible tissue which covers the surface of joints, can get damaged as a result of a sudden injury, such as a sports injury, or gradual wear and tear (osteoarthritis). Symptoms include – knee joint pain, swelling, stiffness and clicking or grinding sensation.
• Chondromalacia patellae – This condition occurs when the cartilage on the undersurface of the patella (kneecap) deteriorates and softens. It is the result of repetitive wear and tear of the kneecap that can occur due to acute injury to the patella or due to aging. A work or sports activity that puts great stress on the knee increases the risk of developing chondromalacia patella.

Knee Injury Diagnosis, Treatment and Rehabilitation

Diagnosis will typically begin with a detailed physical examination of the joint, wherein the physician will examine the bones and check whether any of the joints are out of place. Diagnostic imaging tests such as x-ray and MRI scan may be conducted to examine the condition of the bones, cartilage, muscles, ligaments and tendons and the extent of injury. Once the diagnosis is established, a team of pain management professionals will collaborate to develop an appropriate treatment plan.

Knee injuries that are not severe can be effectively treated without surgery. The first course of action is rest, application of ice packs and a compression bandage. Most minor injuries improve with rest (after two to three weeks). However, if the pain persists beyond three weeks despite these measures, medical treatment will be necessary.

Multispecialty pain management centers in Brooklyn, NYC offer effective nonsurgical treatment modalities to address chronic pain symptoms. Nonsurgical modalities used in knee injury treatment include – physical therapy, injections, anti-inflammation medications, TENS (Transcutaneous Electrical Nerve Stimulation), and Game Ready Cold Therapy.

Exercises to Strengthen the Knee Joint

Physical therapy for knee injury will include exercises to strengthen the muscles and improve flexibility. Strengthening exercises help build up the muscles around the joints. Strengthening the muscles around the knee such as the quadriceps and hamstrings will reduce stress on the joint and help it absorb shock. Gentle stretching or flexibility exercises stretch the muscles in order to restore range of motion, reduce muscle soreness, and prevent injury. In addition, patients will be educated on how to manage injury when it occurs and how to prevent re-injury. This will help prevent potential damage and disability in the long-term.

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In the evolving healthcare landscape, hospitals and medical practices need new revenue cycle management (RCM) strategies. Choosing an experienced, technologically savvy medical billing service provider will ensure valuable support to optimize reimbursement. However, as the business of healthcare has become very complex, medical billing is no longer a simple administrative function. In a recent Beckers Hospital Review report, industry experts recommend specific new strategies to ensure that hospitals’ RCM efforts are focused and financially stable.

• Tracking claim denial rate: Following up on claims and denials is a critical aspect to enhance revenue generation. The claims tracking process involves reviewing accounts receivable (AR) and measuring the average number of days it takes to collect the payments due to the healthcare provider, and identifying patterns in payment by insurance companies. Automating key revenue cycle workflows, finding more efficient ways to submit clean claims, and improving collection efforts,and focusing on the appeals process can reduce days in AR and boost cash flow. In fact, AR management is an important element of the RCM solutions provided by medical billing companies.
• Review of chargemaster: Experts recommend that hospitals conduct a comprehensive review of their chargemaster and ensure price transparency for patients. This is an important requirement to prepare for the CMS’ price transparency rule coming into force Jan. 1, 2019. Under CMS’ annual Inpatient Prospective Payment System rule, hospitals need to publish a list of their standard charges online in order to help patients understand the cost of care and prepare for any out-of-pocket costs. CMS also requires providers to update that information every year. A recent report from the National Association of Healthcare Revenue Integrity, an expert recommends that hospitals take the following steps to prepare to post their chargesmaters online:
  • Review existing state hospital pricing and price transparency requirements
  • Review the chargemaster for consistent pricing
  • Inform all stakeholders about the new requirements, including IT personnel responsible for the online posting of the chargemaster
  • Fix a date for post the chargemaster
  • Create customer service scripts to deal with patients’ questions about the chargemaster and pricing
• Price transparency is critical to boost patient satisfaction and collection of patient financial responsibility.
  • Reduce operating room delays and last-minute cancellations:Operating rooms are a very costly area of hospital operations.Depending upon the complexity of the procedure, last-minute cancellations or delays can prove very costly for hospitals. When planned surgical procedures are cancelled, it leads to considerable loss of revenue and waste of resources,and also results in significant psychological, social and financial consequences for patients and their families.Experts say that, to improve financial performance, hospitals should review their OR operations for avoidable costs and focus on minimizing cancellations and delays in procedures.

  Strategies to improve OR operations include focusing on same-day cancellations, on-time procedure starts, equipment availability and parallel processing to increase efficiency.

  • Blocking OR time by the day rather than stints of hourly blocks
  • Adjusting block times based on the balance between under- and overutilization of the OR
  • Avoiding potential delays and gaps for missing equipment by assessing the risk of potential problems in advance
  • Avoiding tardiness in the OR by starting cases on time
  • Turnover time reductions:

However, as ORs differ considerably based on patient population, type of hospital and type of surgery and anesthesia, it is difficult to set universal benchmarks for all Ors.

• Using online estimator tools to help patients understand their potential out-of-pocket costs: In an era of regulation, high-deductible plans and increased patient responsibility for bills, using a customer-friendly online estimator can ensure that patients get the information they want. Experian’s price-estimator tool, for instance, calculates patients’ out-of-pocket cost based on the hospital’s chargemaster price, its claims history for providing that service, its contract terms with the patient’s insurer, and the patient’s benefit structure and deductible status. It also estimates out-of-pocket costs for self-pay patient. Using a price estimator tool can boost patient satisfaction and attract more patients. Experts advise that when using the tool, hospitals should also post a disclaimer with standard charges, so patients know that the price list they are viewing may not indicate their actual out-of-pocket costs.

• Include both clinical interactions and nonclinical interactions when considering net promoter scores: Net promoter scores reflect how likely patients are likely to recommend the organization to another person. Patient care involves both clinical and nonclinical support services. Even the best clinical services cannot be truly optimal without dedicated nonclinical and clinical-support staff.Experts recommend that hospitals include both clinical interactions and nonclinical interactions when considering net promoter scores. Healthcare providers need to use the same approach as retail businesses and tap into what the patient not only wants but also expects by examining how every nonclinical touchpoint is interacting with the patient. Net promotion scores will provide hospitals with a more accurate picture of patient satisfaction.

Medical billing is the core of healthcare RCM. The medical billing process is complex and difficult to manage, but with the right processes, proactive strategies, and the support of an experienced medical billing and coding company, providers canoptimize RCM and reduce days in accounts receivable.

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