2025 CPT code 11422
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Integumentary System Surgery Feed
Excision of a benign skin lesion (excluding skin tags), 1.1 to 2.0 cm in diameter, including margins, with simple closure.
Modifiers such as 51 (multiple procedures), 59 (distinct procedural service), and others may be applicable depending on the specific circumstances of the procedure and the payer's guidelines.Consult the most recent CPT guidelines and payer instructions.
The medical necessity for excision of a benign lesion is determined by the potential for cosmetic concerns, functional impairment, risk of bleeding, potential for complications, or patient anxiety regarding the lesion's appearance.Documentation supporting these reasons is necessary for appropriate reimbursement.
The physician or qualified healthcare professional is responsible for pre-operative assessment, administering local anesthesia, performing the surgical excision of the lesion, ensuring complete removal of the lesion and adequate margins, hemostasis (stopping any bleeding), and simple wound closure.Post-operative care and follow-up are also the responsibility of the physician.
In simple words: The doctor removes a non-cancerous growth from the skin (excluding skin tags) that is between 1.1 and 2.0 centimeters wide, including a small area around it for safety. They use local anesthetic (numbs the area), remove the growth completely, and stitch up the area with simple stitches.
This CPT code encompasses the surgical excision of a benign lesion, excluding skin tags,measuring 1.1 to 2.0 cm in diameter, inclusive of margins necessary for complete removal.The procedure includes local anesthesia and simple (non-layered) closure of the resulting wound.The lesion's greatest clinical diameter, plus the narrowest necessary margin for complete excision, determines code selection.The excised diameter remains consistent regardless of whether the defect is repaired linearly or reconstructed (e.g., with a skin graft).If more complex closure is needed, additional codes should be used to reflect the level of surgical repair.
Example 1: A 55-year-old male presents with a 1.5 cm benign nevus on his right forearm. The physician performs an elliptical excision with a 2mm margin, sends the tissue for pathology, and performs a simple closure.Code 11422 is used., A 28-year-old female has a 1.8 cm fibroma excised from her left cheek.Local anesthesia is administered, the lesion is completely excised with a 3 mm margin, and the wound is closed using simple interrupted sutures. Code 11422 is appropriately used., A 72-year-old male presents with multiple benign lesions on his back. One lesion measures 1.2 cm and two lesions measure 1.9 cm.The physician excises all three lesions and closes the wounds with simple sutures. Code 11422 is used for the first lesion, and the other two lesions will require modifier 59 because they are separate distinct procedural services.
The medical record should include: pre-operative diagnosis, lesion size and location, details of the surgical procedure (excision technique, margins), pathology report if applicable, closure technique, and post-operative instructions.
** Accurate measurement of the lesion and margins is critical for selecting the correct CPT code.Always refer to the most current CPT manual for the most up-to-date guidelines and code descriptions.
- Revenue Code: P5A (Ambulatory Procedures - Skin)
- Payment Status: Active
- Modifier TC rule: A Technical Component (TC) modifier is generally not applicable to this code.
- Specialties:Dermatology, Plastic Surgery, General Surgery
- Place of Service:Office, Ambulatory Surgical Center, Hospital Outpatient Department