11103

Tangential Biopsy of Skin, Each Separate/Additional Lesion (Add-on Code)

CPT 11103 is a procedural add-on code used to report each additional tangential biopsy of the skin performed during the same operative session as the primary biopsy. A tangential biopsy is a technique where the physician uses a sharp instrument, such as a scalpel blade, a flexible razor, or a curette, to remove a superficial sample of a skin lesion. This method includes techniques commonly referred to as a shave biopsy, scoop biopsy, saucerization, or curettage. Unlike an excision, a tangential biopsy is a partial-thickness procedure that removes the epidermis and a portion of the dermis but does not typically extend into the subcutaneous fat. The physician performs the biopsy by holding the instrument parallel to the skin surface to 'shave' off the lesion. This code is specifically intended for 'additional' lesions; therefore, it must always be reported in conjunction with the primary tangential biopsy code 11102. The procedure includes the preparation of the site, administration of local anesthesia (e.g., lidocaine with epinephrine), the actual sampling of the tissue, and achieving hemostasis through methods such as chemical cautery (aluminum chloride) or electrocautery. The resulting wound is usually left to heal by secondary intention and does not require sutures. The collected specimen is then placed in a preservative and sent for histopathological examination. Documentation must support the medical necessity for sampling each distinct lesion and must clearly identify the anatomical location of each separate biopsy site.

Clinical Indications

  • Suspicious pigmented lesions or nevi
  • Suspected basal cell carcinoma (BCC)
  • Suspected squamous cell carcinoma (SCC) or SCC in situ (Bowen's disease)
  • Raised lesions of uncertain etiology
  • Monitoring of rapidly changing or irregular skin growths
  • Actinic keratosis showing signs of malignant transformation
  • Differentiating between benign seborrheic keratosis and malignant lesions
  • Evaluating chronic non-healing ulcers for malignancy

Procedure Steps

  1. Identify and mark the target lesion(s) for biopsy.
  2. Cleanse the skin site using an antiseptic solution such as alcohol or chlorhexidine.
  3. Administer local anesthesia, typically 1% lidocaine with epinephrine, via intradermal injection to create a wheal.
  4. Stabilize the skin by applying tension with the non-dominant hand.
  5. Perform the tangential shave or scoop using a scalpel or specialized biopsy blade held parallel to the skin surface.
  6. Remove the tissue sample and immediately place it in a specimen container with fixative (e.g., 10% formalin).
  7. Apply pressure to the site to control initial bleeding.
  8. Perform hemostasis using chemical cauterization (e.g., Monsel's solution or aluminum chloride) or electrocautery if necessary.
  9. Apply a topical antibiotic ointment or petroleum jelly and a sterile adhesive bandage.
  10. Label the specimen container with the patient's name and the specific anatomical site of the biopsy.

Coding Guidelines

  • CPT 11103 is an add-on code and must never be reported as a standalone code.
  • Always report 11103 in conjunction with the primary code 11102 (for the first tangential biopsy).
  • Modifier 51 (Multiple Procedures) should not be appended to this add-on code.
  • If different types of biopsies are performed (e.g., one tangential and one punch), the primary code for the most complex technique (e.g., punch 11104) is reported first, and the tangential biopsy for the second lesion would then be reported using 11103.
  • Multiple units of 11103 may be reported if three or more tangential biopsies are performed (e.g., one unit of 11102 and two units of 11103).
  • The procedure includes local anesthesia and simple wound care; these components should not be billed separately.
  • The pathology examination (88304/88305) is billed separately by the pathologist.

Associated ICD-10 Codes