How To Use CPT Code 11421

CPT 11421 refers to the excision of a benign lesion, excluding skin tags, on specific body areas with a diameter of 0.6 to 1.0 cm. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 11421.

1. What is CPT 11421?

CPT 11421 is a medical billing code used to describe the excision of a benign lesion, excluding skin tags, on specific body areas such as the scalp, neck, hands, feet, and genitalia. The excised lesion should have a diameter of 0.6 to 1.0 cm, including margins. This code is used by medical professionals to accurately document and bill for this specific procedure.

2. 11421 CPT code description

The official description of CPT code 11421 is: “Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm.”

3. Procedure

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 skin of the scalp, neck, hands, feet, or genitals.
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 11421 services are those with a benign lesion, excluding skin tags, on the scalp, neck, hands, feet, or genitalia. The lesion must have a diameter of 0.6 to 1.0 cm, including margins. The provider must determine that the lesion requires excision for medical reasons, such as potential malignancy, infection, or interference with daily activities.

5. When to use CPT code 11421

It is appropriate to bill the 11421 CPT code when a medical professional performs the excision of a benign lesion, excluding skin tags, on the specified body areas with a diameter of 0.6 to 1.0 cm, including margins. The code should be used when the provider has determined that the lesion requires excision for medical reasons and has completed the procedure as described.

6. Documentation requirements

To support a claim for CPT 11421, the following information should be documented in the patient’s medical record:

• Location of the lesion (scalp, neck, hands, feet, or genitalia)
• Size of the lesion, including margins (0.6 to 1.0 cm)
• Reason for excision (medical necessity)
• Details of the procedure, including anesthesia, excision technique, and wound closure
• Any laboratory analysis of the excised lesion, if applicable

7. Billing guidelines

When billing for CPT code 11421, it is essential to follow the appropriate guidelines and rules. If multiple lesions of the same or different diameters are excised during the same session, apply modifier 59, Distinct procedural service, to the code(s) for the additional lesion(s). Additionally, differentiate between codes for shaving and excision by considering the removal’s depth. Excision involves full thickness, or through the dermis, while shaving involves sharp removal without a full-thickness dermal excision.

8. Historical information

CPT 11421 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), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm.”

9. Similar codes to CPT 11421

Five similar codes to CPT 11421 differentiate as follows:

• CPT 11420: Excision of a benign lesion with a diameter of 0.5 cm or less.
• CPT 11422: Excision of a benign lesion with a diameter of 1.1 to 2.0 cm.
• CPT 11423: Excision of a benign lesion with a diameter of 2.1 to 3.0 cm.
• CPT 11424: Excision of a benign lesion with a diameter of 3.1 to 4.0 cm.
• CPT 11426: Excision of a benign lesion with a diameter of over 4 cm.

10. Examples

1. Excision of a 0.8 cm benign lesion on the scalp, including margins.
2. Excision of a 1.0 cm benign lesion on the neck, including margins.
3. Excision of a 0.6 cm benign lesion on the hand, including margins.
4. Excision of a 0.9 cm benign lesion on the foot, including margins.
5. Excision of a 0.7 cm benign lesion on the genitalia, including margins.
6. Excision of two benign lesions on the neck, one measuring 0.6 cm and the other 1.0 cm, including margins.
7. Excision of a 0.8 cm benign lesion on the scalp and a 1.2 cm benign lesion on the neck, including margins.
8. Excision of a 0.9 cm benign lesion on the hand and a 0.6 cm benign lesion on the foot, including margins.
9. Excision of a 0.7 cm benign lesion on the genitalia and a 1.0 cm benign lesion on the neck, including margins.
10. Excision of three benign lesions on the scalp, measuring 0.6 cm, 0.8 cm, and 1.0 cm, including margins.