Skin Biopsy

What it is

A great many skin problems look alike from a foot away. A mole that has darkened, a scaly patch that will not heal, a rash that has outlasted every cream — the eye can narrow the list but rarely close it, and the answer lives in the architecture of the tissue itself. A biopsy takes enough skin to see that architecture. The version this code describes is the shallow one, taken parallel to the surface: after numbing the area, the clinician uses a blade, a curved razor or a small curette to shave or scoop off the lesion and the layer beneath it. No stitches are needed, because nothing has been cut down to the fat. Deeper techniques exist — a punch that takes a core through the full thickness of the skin, or a wedge cut out with a scalpel — and those are separate codes at separate prices. This one applies to a single lesion; each extra lesion sampled at the same visit is billed on top.

Why it is done

• To find out whether a changing mole or a growing spot is a skin cancer, and if so what kind
• To diagnose a rash that has not responded to treatment or does not fit a clear pattern
• To confirm an inflammatory skin condition such as psoriasis or lichen planus when the appearance is ambiguous
• To identify a fungal, bacterial or viral infection of the skin
• To check whether a previously treated area still contains abnormal cells

What to expect

This is an office procedure. The site is cleaned and a small injection of local anesthetic goes in — a brief sting, and the only part most people feel. The sample itself takes seconds. Bleeding is stopped with pressure, a cautery instrument or a topical agent, and a dressing goes on. A shallow biopsy site heals as a shallow open wound rather than a sutured line, kept clean and covered for a week or two, and it usually leaves a flat pale mark. The tissue goes to a pathologist, so results are not immediate; a report typically comes back in a few days to a couple of weeks. A biopsy is a sample, not necessarily a cure — if a cancer is found, removing it properly is a further procedure.

Questions worth asking

• The pathologist's bill is separate from the office visit and arrives later, sometimes from a laboratory you never chose. Ask which lab the practice sends to and whether it is in your network.
• Pathology is frequently billed per specimen. If more than one spot is sampled today, ask how many separate specimens that becomes.
• Extra lesions biopsied at the same visit add their own charges. Ask what each additional one costs before agreeing to do several at once.
• Ask whether the visit itself is billed in addition to the procedure, or whether the procedure charge absorbs it.
• If the plan is to remove the lesion completely rather than sample it, ask which is being billed. A removal and a biopsy are different codes, and the answer changes both the bill and what happens to the specimen.