What are Benign Lesions
Benign lesions are contained, ie, they lack the ability to invade neighboring tissues, or metastasize. Skin lesions that are considered benign include lipomas, cysts, fibromas, nevi, and some moles. The codes in this series are used to report the excision of benign lesions that originate in the integumentary system. The actual lesion and excision may extend beyond the integumentary system. A margin of healthy full-thickness skin is usually excised with the benign lesion. The diameter of the entire excision (including margin) is used to calculate the measurement necessary for CPT code selection.
Any repair of the surgical site that requires layered closure, extensive undermining, or retention sutures may be reported separately. When the morphology of a lesion is ambiguous, the coder should choose the excision code category (malignant vs benign) based on the physician’s approach to the lesion rather than the final pathology report. In this way, the coding will reflect the physician’s knowledge, skill, time, and effort, regardless of the pathology report. For example, a lesion suspected of being benign would be excised with relatively smaller margins than a lesion suspected of being malignant.
Read also: Coding sample report for skin lesion CPT code
CPT codes for Coding Benign lesion
When the lesion is clearly benign (eg, cyst, lipoma, prior biopsy of benign neoplasm), the excision can be coded as benign at the time of surgery from code series CPT 11400-11471.
11400 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less 11401 excised diameter 0.6 to 1.0 cmÂ
11402 excised diameter 1.1 to 2.0 cmÂ
11403 excised diameter 2.1 to 3.0 cmÂ
11404 excised diameter 3.1 to 4.0 cmÂ
11406 excised diameter over 4.0 cmÂ
(For unusual or complicated excision, add modifier 22)Â 11420 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or lessÂ
11421 excised diameter 0.6 to 1.0 cmÂ
11422 excised diameter 1.1 to 2.0 cmÂ
11423 excised diameter 2.1 to 3.0 cmÂ
11424 excised diameter 3.1 to 4.0 cmÂ
11426 excised diameter over 4.0 cmÂ
(For unusual or complicated excision, add modifier 22)Â 11440 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or lessÂ
11441 excised diameter 0.6 to 1.0 cmÂ
11442 excised diameter 1.1 to 2.0 cmÂ
11443 excised diameter 2.1 to 3.0 cmÂ
11444 excised diameter 3.1 to 4.0 cmÂ
11446 excised diameter over 4.0 cmÂ
During the excision of a skin lesion, the physician determines how much margin of healthy skin
should be removed based on the lesion’s appearance. The resultant defect may be closed simply or
may require intermediate or complex closure, which can be reported in addition to the CPT code for
the excision.
What are Malignant Lesion?
Malignant lesions have the ability to invade neighboring tissues, or metastasize. Skin neoplasms that are considered malignant include melanoma; basal cell, squamous cell, and Merkel cell carcinoma; and Kaposi sarcoma. The CPT codes in this series are used to report the excision of malignant lesions of cutaneous origin in the integumentary system. The actual malignancy and excision may extend beyond the integumentary system. A wide margin of healthy full-thickness skin or other surrounding tissue also is excised with the malignant lesion. Any repair of the surgical site that requires layered closure, extensive undermining, retention sutures, or flaps and grafts may be reported separately.
11600 Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.5 cm or lessÂ
11601 excised diameter 0.6 to 1.0 cmÂ
11602 excised diameter 1.1 to 2.0 cmÂ
11603 excised diameter 2.1 to 3.0 cmÂ
11604 excised diameter 3.1 to 4.0 cmÂ
11606 excised diameter over 4.0 cmÂ
11620 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or lessÂ
11621 excised diameter 0.6 to 1.0 cmÂ
11622 excised diameter 1.1 to 2.0 cmÂ
11623 excised diameter 2.1 to 3.0 cmÂ
11624 excised diameter 3.1 to 4.0 cmÂ
11626 excised diameter over 4.0 cmÂ
11640 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.5 cm or lessÂ
11641 excised diameter 0.6 to 1.0 cmÂ
11642 excised diameter 1.1 to 2.0 cmÂ
11643 excised diameter 2.1 to 3.0 cmÂ
11644 excised diameter 3.1 to 4.0 cmÂ
11646 excised diameter over 4.0 cmÂ
Selection of the appropriate excision code is determined by three parameters: location, maximum excised diameter (which includes the margin), and lesion type (ie, benign or malignant). When there is a prior biopsy showing malignancy, the excision can be coded as malignant at the time of surgery (11600-11646). In addition, if the lesion is not clearly benign or malignant, coding and billing should be delayed until the pathology has been confirmed.
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