What is the CPT Code for a Punch Biopsy Procedure?

In medical billing and coding, accuracy is the foundation of proper reimbursement. A small error in selecting a CPT (Current Procedural Terminology) code can lead to denials, delays, or compliance issues. If you’re wondering, “What is the CPT code for a punch biopsy procedure?” this article explains everything you need to know.

What is a Punch Biopsy?

A punch biopsy is a diagnostic procedure where a special circular blade (punch tool) removes a cylindrical section of skin. The tissue sample often includes the epidermis, dermis, and sometimes the upper fat layer, which is then sent for histopathology.

This method helps diagnose dermatologic conditions, infections, or suspicious lesions. Since the technique is unique, specific CPT codes apply to punch biopsies.

CPT Codes for Punch Biopsy

In 2019, the American Medical Association (AMA) revised biopsy coding to categorize procedures by method of removal rather than lesion size or body location.

For punch biopsy procedures, the relevant codes are:

Key Notes:

• Simple closure is included in CPT 11104. Do not bill it separately.
• Use 11105 for each additional punch biopsy lesion performed in the same session.
• If multiple biopsy methods are performed (e.g., punch + tangential), apply the primary method code and then add the appropriate add-on codes.

Why Correct Coding Matters

Choosing the correct punch biopsy CPT code is more than compliance—it directly impacts your bottom line.

Reimbursement – Correct coding ensures payers reimburse accurately for the work done.
Compliance – Prevents errors that could trigger audits or penalties.
Efficiency – Reduces claim rework and denial management workload.

Best Practices for Punch Biopsy Coding

• Document method (punch), lesion count, and closure status clearly.
• Apply 11104 for the first lesion and 11105 for each additional.
• For mixed biopsy methods, use the highest-valued code first.
• Stay current with CPT updates to avoid outdated or incorrect coding.

How EZ Settle Solutions Helps

At EZ Settle Solutions, we help providers and practices eliminate coding errors and streamline revenue cycle management. Our certified coders ensure procedures like punch biopsies are billed accurately with 11104 / 11105, backed by proper documentation and payer compliance.

• Follow us on LinkedIn to stay updated with medical coding insights.
• Watch guides and tips on our EZ Settle Solutions YouTube Channel.
•  Learn more about the importance of Revenue Cycle Management in medical billing.

For detailed guidance, check the AMA CPT Coding Overview for the latest standards and updates.

Final Takeaway

• 11104 → Punch biopsy of skin, first lesion (closure included)
• 11105 → Each additional punch biopsy lesion
• Document everything: method, number of lesions, and closures.
• Partnering with experts like EZ Settle Solutions ensures compliance, correct reimbursement, and fewer claim denials.