Biopsy and excision same lesion same day (Updated for 2026)

Common Causes for D10

Denials with code D10 typically happen for the following specific reasons:

• Billing both a diagnostic biopsy code and a therapeutic excision code for the exact same lesion during the same clinical encounter.
• Inappropriate use of Modifier 59 or XS to bypass bundling edits when the biopsy and excision were actually performed on the same lesion.
• Lack of detailed documentation in the operative report distinguishing separate lesion locations, leading the payer to assume they were the same site.
• Inadequate clinical documentation failing to support that a biopsy was performed on a separate lesion prior to the decision to excise another.

How to Prevent D10 Denials

To avoid receiving this denial in the future, implement these specific checks:

• Train coding staff to apply the definitive excision code only and omit the biopsy code when both are performed on the same lesion.
• Utilize front-end claim scrubs to flag concurrent billing of biopsy and excision codes on the same date of service for clinical review.
• Ensure providers document the precise anatomical location, size, and distinct nature of each lesion when multiple procedures are performed.
• Only append Modifier 59 or XS when documentation clearly supports that the biopsy and excision occurred at distinct, separate anatomical sites or different lesions.

Appeal Letter Template for D10

If you believe this claim was denied incorrectly, you can use the following template to submit an appeal.

[Your Practice Header]
[Date]

[Payer Name]
[Appeals Department Address]

RE: Appeal for Claim [Claim Number]
Patient: [Patient Name]
ID: [Patient ID]
Date of Service: [Date]
Denial Code: D10 - Biopsy and excision same lesion same day

Dear Appeals Department,

I am writing to appeal the denial of the above-referenced claim, which was denied with code D10: "Biopsy and excision same lesion same day".

According to AMA CPT and CMS National Correct Coding Initiative (NCCI) guidelines, a biopsy and a surgical excision are separately reportable when performed on different lesions or at distinct anatomical sites. The enclosed medical record and operative report clearly document that the biopsy and the excision were performed on two separate and distinct lesions located at different anatomical sites. As these procedures do not represent the same lesion, the application of the distinct procedural modifier (59/XS) is correct and fully supported by the clinical documentation. We respectfully request that you review the attached clinical records, overturn this denial, and allow separate reimbursement for both distinct procedures.

Attached please find:
1. A copy of the original claim.
2. The relevant medical records supporting the service.
3. [Any other supporting documents].

We respectfully request that you reprocess this claim for payment.

Sincerely,

[Your Name]
[Title]
[Practice Name]