2025 CPT code 11426
Effective Date: N/A Revision Date: N/A Surgery - Integumentary System Feed
Excision of a benign lesion, excluding skin tags, larger than 4.0 cm in diameter, including margins, from the scalp, neck, hands, feet, or genitalia.
Modifier 22 (Increased Procedural Services) can be appended for unusually complex or time-consuming excisions.
Medical necessity must be documented and justify why excision was chosen over other methods. Reasons could include suspicion of malignancy, lesion size or location causing functional impairment, or patient preference based on informed consent about alternative treatments.
The physician prepares the patient, uses local anesthesia, and then completely removes the lesion with appropriate margins, ensuring proper depth. The specimen may be sent for analysis, bleeding is controlled, and the wound is closed with a single layer.
In simple words: Removal of a non-cancerous skin growth, bigger than 4 centimeters, from sensitive areas like the scalp, neck, hands, feet, or genitals.This includes removing some of the healthy skin around the growth to ensure it's completely gone.
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm. This includes full-thickness removal through the dermis, along with necessary margins, and simple closure.
Example 1: A patient presents with a 5cm benign cyst on the scalp. The physician excises the cyst with appropriate margins and closes the wound., A patient has a 4.5cm nevus on the hand.The physician removes the nevus entirely, including margins, and performs a simple closure., A patient has a large, benign lipoma on the neck measuring 6 cm in diameter.The physician excises the lipoma and closes the site with a simple closure. The removed tissue is sent for pathological examination.
Documentation must support the medical necessity for excision, the lesion's size (including margins), location, and the complexity of the closure. Pathology reports should be included if applicable.
- Specialties:Dermatology, Plastic Surgery, General Surgery, Family Medicine
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center