How To Use CPT Code 11404

CPT 11404 refers to the excision of a benign lesion, excluding skin tags, on the trunk, arms, or legs with a diameter of 3.1 to 4.0 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 11404 procedures.

1. What is CPT 11404?

CPT 11404 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 3.1 to 4.0 cm, including margins. This code is used by medical professionals to accurately document and bill for this specific procedure.

2. 11404 CPT code description

The official description of CPT code 11404 is: “Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm.”

3. Procedure

The CPT 11404 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 3.1 to 4.0 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 excised lesion 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 11404 services are those with a benign lesion, excluding skin tags, on the trunk, arms, or legs with a diameter of 3.1 to 4.0 cm, including margins. The lesion must be noncancerous and not listed elsewhere in the CPT code system.

5. When to use CPT code 11404

It is appropriate to bill the 11404 CPT code when a medical professional performs the excision of a benign lesion, excluding skin tags, on the trunk, arms, or legs with a diameter of 3.1 to 4.0 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 11404, 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
• Any complications encountered during the procedure
• Pathology report, if the excised lesion was submitted for analysis
• Postoperative care instructions and follow-up plan

7. Billing guidelines

When billing for CPT code 11404, it is essential to follow the appropriate guidelines and rules. Some tips and codes that apply to CPT code 11404 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 11404, including the size, location, and type of lesion.
• Be aware of similar codes with different lesion diameters and ensure the correct code is used for the specific procedure performed.

8. Historical information

CPT 11404 was added to the Current Procedural Terminology system on January 1, 1990. The code descriptor was changed on January 1, 2003, to its current form.

9. Similar codes to CPT 11404

Five similar codes to CPT 11404 differentiate as follows:

• CPT 11400: Excision of a benign lesion with a diameter of 0.5 cm or less.
• CPT 11401: Excision of a benign lesion with a diameter of 0.6 to 1 cm.
• 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 11406: Excision of a benign lesion with a diameter of over 4.0 cm.

10. Examples

Here are 10 detailed examples of CPT code 11404 procedures:

1. Excision of a 3.5 cm diameter seborrheic keratosis on the patient’s upper arm.
2. Removal of a 3.2 cm diameter lipoma on the patient’s lower back.
3. Excision of a 4.0 cm diameter epidermoid cyst on the patient’s thigh.
4. Removal of a 3.1 cm diameter dermatofibroma on the patient’s forearm.
5. Excision of a 3.8 cm diameter pilomatricoma on the patient’s shoulder.
6. Removal of a 3.4 cm diameter nevus on the patient’s abdomen.
7. Excision of a 3.9 cm diameter pyogenic granuloma on the patient’s calf.
8. Removal of a 3.3 cm diameter keloid on the patient’s chest.
9. Excision of a 3.6 cm diameter xanthoma on the patient’s upper leg.
10. Removal of a 3.7 cm diameter angiolipoma on the patient’s lower arm.