How To Use CPT Code 11403
CPT 11403 refers to the excision of a benign lesion, excluding skin tags, on the trunk, arms, or legs with a diameter of 2.1 to 3.0 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 11403 procedures.
1. What is CPT 11403?
CPT 11403 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 2.1 to 3.0 cm, including margins. This code is used by medical coders and billers to accurately document and bill for this specific procedure.
2. 11403 CPT code description
The official description of CPT code 11403 is: “Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0 cm.”
The 11403 procedure involves the following steps:
- The patient is appropriately prepped, and the area is anesthetized.
- The provider holds a scalpel or other bladed instrument perpendicular to the benign lesion, not a skin tag, measuring 2.1 to 3.0 cm in diameter, including margins, on the trunk, arms, or legs.
- The provider excises down into the subcutaneous tissue in an elliptical, wedge, or circular shape to remove the entire lesion.
- The excised lesion may be submitted to a laboratory for analysis.
- The provider checks for bleeding and then closes the wound in a single layer.
4. Qualifying circumstances
Patients eligible to receive CPT code 11403 services are those with a benign lesion, excluding skin tags, on the trunk, arms, or legs with a diameter of 2.1 to 3.0 cm, including margins. The lesion must be noncancerous and not listed elsewhere in the CPT code system.
5. When to use CPT code 11403
It is appropriate to bill the 11403 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 2.1 to 3.0 cm, including margins. The code should be used only when the procedure meets the specific criteria outlined in the CPT code description.
6. Documentation requirements
To support a claim for CPT 11403, the following information should 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 the excision technique and closure method
- Any complications encountered during the procedure
- Pathology report, if the excised lesion was submitted for analysis
7. Billing guidelines
When billing for CPT code 11403, it is essential to follow the appropriate guidelines and rules. Some tips and codes that apply to CPT code 11403 include:
- Use modifier 59, Distinct procedural service, when billing for multiple lesions of different diameters excised during the same session.
- Ensure that the documentation supports the use of CPT code 11403, including the size, location, and type of lesion.
- Be aware of similar codes with different lesion diameters and ensure the correct code is used based on the specific procedure performed.
8. Historical information
CPT 11403 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 2.1 to 3.0 cm.”
9. Similar codes to CPT 11403
Five similar codes to CPT 11403 differentiate based on the diameter of the lesion being excised:
- CPT 11400: excision of a lesion with a diameter of 0.5 cm or less
- CPT 11401: excision of a lesion with a diameter of 0.6 to 1 cm
- CPT 11402: excision of a lesion with a diameter of 1.1 to 2.0 cm
- CPT 11404: excision of a lesion with a diameter of 3.1 to 4.0 cm
- CPT 11406: excision of a lesion with a diameter of over 4.0 cm
Here are 10 detailed examples of CPT code 11403 procedures:
- Excision of a 2.5 cm diameter seborrheic keratosis on the patient’s upper arm
- Removal of a 3.0 cm diameter lipoma on the patient’s lower back
- Excision of a 2.1 cm diameter epidermoid cyst on the patient’s thigh
- Removal of a 2.8 cm diameter dermatofibroma on the patient’s forearm
- Excision of a 2.3 cm diameter pilomatricoma on the patient’s calf
- Removal of a 2.9 cm diameter pyogenic granuloma on the patient’s shoulder
- Excision of a 2.2 cm diameter nevus on the patient’s chest
- Removal of a 2.7 cm diameter keloid on the patient’s upper back
- Excision of a 2.4 cm diameter xanthoma on the patient’s abdomen
- Removal of a 3.0 cm diameter angiolipoma on the patient’s lower leg