How To Use CPT Code 11422

CPT 11422 refers to the excision of a benign lesion, excluding skin tags, with a diameter of 1.1 to 2.0 cm on specific body areas. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 11422.

1. What is CPT 11422?

CPT 11422 is a medical billing code used to describe the excision of a benign lesion, excluding skin tags, with a diameter of 1.1 to 2.0 cm on specific body areas such as the scalp, neck, hands, feet, and genitalia. This code is used by medical professionals to accurately document and bill for this specific procedure.

2. 11422 CPT code description

The official description of CPT code 11422 is: “Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm.”

3. Procedure

The procedure for CPT 11422 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 1.1 to 2.0 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 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 11422 services are those with a benign lesion, excluding skin tags, with a diameter of 1.1 to 2.0 cm on the scalp, neck, hands, feet, or genitalia. 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 11422

It is appropriate to bill the 11422 CPT code when a provider performs the excision of a benign lesion, excluding skin tags, with a diameter of 1.1 to 2.0 cm on the specified body areas. The code should be used when the procedure is medically necessary and the patient meets the qualifying circumstances outlined above.

6. Documentation requirements

To support a claim for CPT 11422, 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 specimen was submitted for analysis
• Postoperative care instructions and follow-up plan

7. Billing guidelines

When billing for CPT code 11422, 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 11422 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 1.1 to 2.0 cm.”

9. Similar codes to CPT 11422

Five similar codes to CPT 11422 differentiate as follows:

• CPT 11420: Excision of a benign lesion with a diameter of 0.5 cm or less on the specified body areas.
• CPT 11421: Excision of a benign lesion with a diameter of 0.6 to 1.0 cm on the specified body areas.
• CPT 11423: Excision of a benign lesion with a diameter of 2.1 to 3.0 cm on the specified body areas.
• CPT 11424: Excision of a benign lesion with a diameter of 3.1 to 4.0 cm on the specified body areas.
• CPT 11426: Excision of a benign lesion with a diameter of over 4 cm on the specified body areas.

10. Examples

Here are 10 detailed examples of CPT code 11422 procedures:

1. Excision of a 1.5 cm benign nevus on the scalp, including margins.
2. Excision of a 1.2 cm lipoma on the neck, including margins.
3. Excision of a 1.8 cm seborrheic keratosis on the hand, including margins.
4. Excision of a 1.1 cm epidermoid cyst on the foot, including margins.
5. Excision of a 2.0 cm pyogenic granuloma on the genitalia, including margins.
6. Excision of a 1.3 cm dermatofibroma on the neck, including margins.
7. Excision of a 1.9 cm pilomatricoma on the scalp, including margins.
8. Excision of a 1.4 cm hidradenoma on the hand, including margins.
9. Excision of a 1.7 cm angiokeratoma on the foot, including margins.
10. Excision of a 1.6 cm verruca vulgaris on the genitalia, including margins.