How To Use CPT Code 11406

CPT 11406 refers to the excision of a benign lesion, excluding skin tags, with a diameter over 4.0 cm on the trunk, arms, or legs. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 11406 procedures.

1. What is CPT 11406?

CPT 11406 is a medical billing code used to describe the excision of a benign lesion, excluding skin tags, with a diameter over 4.0 cm on the trunk, arms, or legs. This code is used by medical professionals to accurately document and bill for this specific procedure.

2. 11406 CPT code description

The official description of CPT code 11406 is: “Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm.”

3. Procedure

The CPT 11406 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 greater than 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 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 11406 services are those with a benign lesion, excluding skin tags, with a diameter over 4.0 cm on the trunk, arms, or legs. The lesion must be noncancerous and not listed elsewhere in the CPT code system. The provider must determine that the excision is medically necessary and appropriate for the patient’s condition.

5. When to use CPT code 11406

It is appropriate to bill the 11406 CPT code when a provider performs the excision of a benign lesion, excluding skin tags, with a diameter over 4.0 cm on the trunk, arms, or legs. The code should be used when the procedure meets the specific criteria outlined in the CPT code description and when the provider has determined that the excision is medically necessary and appropriate for the patient’s condition.

6. Documentation requirements

To support a claim for CPT 11406, 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, wound closure, and any complications encountered
• Pathology report, if the specimen was submitted for analysis
• Postoperative care instructions and follow-up plan

7. Billing guidelines

When billing for CPT code 11406, it is essential to follow the appropriate guidelines and rules. Some tips and codes that apply to CPT code 11406 include:

• Use modifier 59, Distinct procedural service, when billing for multiple lesions of different diameters excised during the same session.
• For unusual or complicated excisions, add modifier 22 to the CPT code.
• Ensure that the documentation supports the medical necessity and appropriateness of the procedure.

8. Historical information

CPT 11406 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 over 4.0 cm.”

9. Similar codes to CPT 11406

Five similar codes to CPT 11406 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 11404: Excision of a benign lesion with a diameter of 3.1 to 4.0 cm.

10. Examples

Here are 10 detailed examples of CPT code 11406 procedures:

1. Excision of a 4.5 cm benign lipoma on the patient’s upper arm.
2. Removal of a 5 cm seborrheic keratosis on the patient’s back.
3. Excision of a 4.2 cm epidermoid cyst on the patient’s thigh.
4. Removal of a 6 cm dermatofibroma on the patient’s lower leg.
5. Excision of a 4.8 cm pilomatricoma on the patient’s forearm.
6. Removal of a 5.5 cm nevus on the patient’s abdomen.
7. Excision of a 4.1 cm pyogenic granuloma on the patient’s shoulder.
8. Removal of a 7 cm xanthoma on the patient’s chest.
9. Excision of a 4.3 cm keloid on the patient’s upper back.
10. Removal of a 5.2 cm benign melanocytic nevus on the patient’s calf.