Understanding the 11104 CPT Code

11104 CPT Impact on Medical Billing

In the intricate realm of medical coding and billing, it is of utmost importance for healthcare practitioners, encompassing doctors, medical billers, medical coders, and practice managers, to remain current with the most up-to-date CPT codes and their impact on generating revenue. Among these codes lies the 11104 CPT code, which plays a pivotal role in specific dermatological procedures. Within this blog, we will delve into the intricacies of the 11104 CPT code, examine its influence on billing and revenue, and present pertinent billing scenarios to enhance comprehension.

What is 11104 CPT Code?

The 11104 CPT code is a Current Procedural Terminology (CPT) code that specifically refers to the biopsy of skin lesions. More specifically, it is used for the removal of benign skin lesions, including but not limited to moles, cysts, and lipomas, through a surgical procedure. This code is used when the physician performs a full-thickness removal and closure of the lesion.



Impact on Billing and Revenue: Accurate coding and billing using the 11104 CPT code are essential for healthcare practices to ensure proper reimbursement and maintain a healthy revenue stream. Here are some key impacts of this code on billing and revenue:

Reimbursement Rates for CPT Code 11104

The 11104 CPT code has its own assigned relative value units (RVUs) that determine the reimbursement rates. RVUs take into account various factors such as physician work, practice expenses, and malpractice insurance. It is crucial to verify the RVU assigned to the code to ensure appropriate reimbursement.

11104 CPT Code Documentation

Proper documentation is vital for supporting the use of the 11104 CPT code during billing. Medical coders rely on accurate and comprehensive documentation by the physician to justify the procedure performed. Lack of proper documentation can lead to claim denials or downcoding, resulting in a negative impact on revenue.

Compliance with 11104 CPT Code

Healthcare practices must adhere to coding guidelines and compliance regulations when using the 11104 CPT code. Non-compliance can lead to audits and potential penalties. Ensuring accurate coding, documentation, and adherence to medical necessity criteria is crucial to avoid compliance issues.

Bundled Services with CPT Code 11104

It is important to be aware of bundled services or procedures that may impact billing and revenue when using the 11104 CPT code. Certain services, such as anesthesia, additional excisions, or pathological examination, may be bundled with the biopsy procedure. Understanding the bundling rules and properly coding associated services is essential to avoid revenue loss.

Billing Scenarios of CPT Code 11104

Removal of Benign Skin Lesion

A dermatologist performs a full-thickness removal and closure of a benign skin lesion on a patient's arm. The physician accurately documents the procedure, and the medical coder assigns the 11104 CPT code for billing. The claim is submitted with proper supporting documentation, resulting in successful reimbursement at the predetermined rate.

Multiple Benign Lesions in Different Places

 A patient presents with multiple benign skin lesions in different locations. The dermatologist performs a full-thickness removal and closure for each lesion. In this case, the medical coder should assign the 11104 CPT code for each lesion, ensuring proper documentation and coding accuracy for all individual procedures performed.

Biopsy with Additional Excisions

During the biopsy procedure, the dermatologist encounters complications that require additional excisions and suturing. In this situation, the coder should assign the appropriate CPT codes for both the 11104 biopsy and any additional procedures performed. It is crucial to follow coding guidelines to avoid undercoding or unbundling of services.

Conclusion to Charge Capture Process Optimization

Mastering the charge capture process is essential for medical clinics and coders to thrive in today's healthcare landscape. By understanding the process, identifying common challenges, and implementing best practices, clinics can optimize their revenue cycle, enhance compliance, and streamline workflows. Medical coders play a vital role in ensuring accurate coding and documentation, making their expertise invaluable. Embracing technology solutions, fostering effective communication, and conducting regular audits are key steps toward a successful charge capture process. Let's strive for excellence in charge capture to provide quality care and optimize revenue generation for medical clinics and coders alike.

Ensuring Optimal Approvals of CPT Code 11104

Importance of 1-pass Approvals

Understanding the11104 CPT code is essential for doctors, medical billers, medical coders, and practice managers to effectively navigate the billing and revenue landscape in dermatological procedures. Accurate coding, documentation, compliance, and knowledge of bundled services play a significant role in optimizing revenue and avoiding claim denials or penalties. By grasping the nuances of the 11104 CPT code and implementing best practices, healthcare practices can ensure proper reimbursement and maintain a healthy financial outlook.

Avoiding the Back and Forth Denial Game

Every clinic gets denials, but no clinic should be submitting multiple appeals for a single claim. The administrative fee alone costs your clinic $40.00 per appeal, and no biller or medical coder wants to see a denial hit their inbox! Let's look at an easy solution to get 1-pass approvals.

iVECoder for CPT Code 11104

IVECoder is an AI medical coding tool where you look up any code, avoiding unbundling and bundling errors for CPT code 11104 and any other code in US Healthcare. Run mock adjudications, mock authorizations, look up RVUs based on your GPCI settings, and increase your approval rates on Day 1. We offer month to month IVECoder subscriptions and annual subscriptions. 

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Good luck out there and we're here for you when you need guidance and updates.

Will Schmidt joined PCG Software as their Chief Strategy Officer in November 2022. Prior to PCG, Schmidt lead TNH as their Sr. Vice President to become the 7th largest pharmacy in the nation. He then went on to consult with and serve as Interim CEO or Consultant to over 20 different companies specializing in profit strategies, operational efficiencies, vendor relations and partnerships, and exit strategies, include an international Revenue Cycle Management Company.