How To Use CPT Code 11401

CPT 11401 refers to the excision of a benign lesion, excluding skin tags, on the trunk, arms, or legs with a diameter of 0.6 to 1.0 cm, including margins. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 11401 procedures.

1. What is CPT 11401?

CPT 11401 is a medical billing code used to describe the excision of a benign lesion, excluding skin tags, on the trunk, arms, or legs with a diameter of 0.6 to 1.0 cm, including margins. This code is used by medical coders and billers to accurately document and bill for this specific procedure.

2. 11401 CPT code description

The official description of CPT code 11401 is: “Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 to 1.0 cm.”

3. Procedure

The 11401 procedure involves the following steps:

1. The patient is appropriately prepped, and the area is anesthetized.
2. The provider holds a scalpel or other bladed instrument perpendicular to the benign lesion, not a skin tag, measuring 0.6 to 1.0 cm in diameter, including margins, on the trunk, arms, or legs.
3. The provider excises down into the subcutaneous tissue in an elliptical, wedge, or circular shape to remove the entire lesion.
4. The specimen may be submitted to a laboratory for analysis.
5. The provider checks for bleeding and then closes the wound in a single layer.

4. Qualifying circumstances

Patients eligible to receive CPT code 11401 services are those with a benign lesion, excluding skin tags, on the trunk, arms, or legs with a diameter of 0.6 to 1.0 cm, including margins. The lesion must be noncancerous and not listed elsewhere in the CPT code system.

5. When to use CPT code 11401

It is appropriate to bill the 11401 CPT code when a provider performs the excision of a benign lesion, excluding skin tags, on the trunk, arms, or legs with a diameter of 0.6 to 1.0 cm, including margins. The code should be used to accurately document and bill for this specific procedure.

6. Documentation requirements

To support a claim for CPT 11401, the following information needs to be documented:

• Patient’s medical history and physical examination findings
• Indication for the procedure, including the size, location, and type of lesion
• Description of the procedure, including anesthesia, excision technique, and wound closure
• Postoperative care instructions and follow-up plan
• Pathology report, if the specimen was submitted for analysis

7. Billing guidelines

When billing for CPT code 11401, keep in mind the following guidelines and rules:

• For the same procedure on a lesion with a different diameter, refer to the appropriate CPT code based on the size of the lesion.
• To differentiate between codes for excision and shaving, consider the removal’s depth. Excision involves full thickness, while shaving does not involve a full-thickness dermal excision.
• If a provider excises multiple lesions of different diameters, apply modifier 59, Distinct procedural service, to the code for the second lesion.

8. Historical information

CPT 11401 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2003, with the previous descriptor being “Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm.”

9. Similar codes to CPT 11401

Five similar codes to CPT 11401 differentiate as follows:

• CPT 11400: Excision of a benign lesion with a diameter of 0.5 cm or less.
• CPT 11402: Excision of a benign lesion with a diameter of 1.1 to 2.0 cm.
• CPT 11403: Excision of a benign lesion with a diameter of 2.1 to 3.0 cm.
• CPT 11404: Excision of a benign lesion with a diameter of 3.1 to 4.0 cm.
• CPT 11406: Excision of a benign lesion with a diameter of over 4.0 cm.

10. Examples

Here are 10 detailed examples of CPT code 11401 procedures:

1. Excision of a 0.8 cm diameter seborrheic keratosis on the patient’s upper arm.
2. Removal of a 1.0 cm diameter epidermoid cyst on the patient’s lower back.
3. Excision of a 0.7 cm diameter lipoma on the patient’s thigh.
4. Removal of a 0.9 cm diameter dermatofibroma on the patient’s forearm.
5. Excision of a 0.6 cm diameter pyogenic granuloma on the patient’s leg.
6. Removal of a 1.0 cm diameter pilomatricoma on the patient’s shoulder.
7. Excision of a 0.8 cm diameter nevus on the patient’s chest.
8. Removal of a 0.7 cm diameter angioma on the patient’s upper back.
9. Excision of a 0.9 cm diameter xanthoma on the patient’s lower arm.
10. Removal of a 1.0 cm diameter fibroma on the patient’s abdomen.