2025 CPT code 11424
(Active) Effective Date: N/A Revision Date: N/A Surgery - Excision-Benign Lesions Procedures on the Skin Surgery Feed
Excision of a benign lesion, excluding skin tags, with a diameter of 3.1 to 4.0 cm, including margins, from the scalp, neck, hands, feet, or genitalia.
Modifiers may be applied to this code to indicate additional circumstances such as multiple procedures (modifier 51) or distinct procedural service (modifier 59).
The medical necessity for excision of a benign lesion is established based on the physician's clinical judgment considering factors such as the lesion's size, location, cosmetic concerns, potential for interference with function, patient symptoms, and/or potential for malignant transformation.Documentation must support the medical necessity.
The clinical responsibility involves the physician's assessment of the lesion, appropriate preparation of the patient's skin, administering local anesthesia, performing the excision with precise removal of the lesion and its margins, hemostasis (control of bleeding), and wound closure. Pathologic examination of the excised tissue may also be included.
In simple words: The doctor removes a non-cancerous growth (not a skin tag) that measures 3.1 to 4 centimeters wide, including the surrounding skin needed for complete removal. This is done on the scalp, neck, hands, feet, or genitals, and includes a simple stitch to close the wound.If a more complicated closure is needed, it will be billed separately.
This CPT code represents the surgical excision of a benign lesion (excluding skin tags) measuring 3.1 to 4.0 cm in diameter, encompassing the necessary margins for complete removal.The procedure includes local anesthesia and simple closure. The lesion's location can be on the scalp, neck, hands, feet, or genitalia.The excised diameter is measured before the excision, encompassing the lesion and the narrowest margins required for adequate removal.If more complex closure is needed, additional codes for intermediate or complex closure must be reported separately.This code does not include adjacent tissue transfer; if performed, only the tissue transfer code should be reported.
Example 1: A 55-year-old male presents with a 3.5 cm benign nevus on his right cheek.The physician excises the nevus with a 2 mm margin, performs a simple closure, and sends the tissue for pathology., A 28-year-old female has a 3.8 cm keloid scar on her left shoulder. The physician excises the scar tissue with a 2 mm margin.Due to the size and location, an intermediate closure is required., A 70-year-old male has a 4 cm benign lipoma on his back. The physician excises the lipoma, including margins, using elliptical excision. Simple closure is performed.
Complete patient medical history, physical examination documenting the lesion's size and location, operative report detailing the excision technique (including margin size), type of closure, and any complications.Pathology report confirming benign nature of the excised lesion is required.
** Always confirm code appropriateness based on the specific clinical scenario and payer guidelines.Accurate documentation is vital for proper reimbursement.
- Revenue Code: P5A (AMBULATORY PROCEDURES - SKIN)
- RVU: The RVUs for this code will vary depending on several factors including geographic location and the specific payer. Consult a local fee schedule or relevant payer guidelines for the most accurate RVU and reimbursement information.
- Global Days: The global period for this procedure is dependent on the complexity of the procedure and the payer.Check with specific payers for details.
- Payment Status: Active
- Modifier TC rule: A Technical Component (TC) modifier is not typically used with 11424 as the code itself represents the complete procedure. However, if the service is divided between a physician and another qualified healthcare professional, relevant modifiers might be required.
- Fee Schedule: Historical fee schedule data can vary by payer and location.Consult publicly available fee schedules and historical data from relevant payers.
- Specialties:Dermatology, Plastic Surgery, General Surgery
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)