How To Use CPT Code 11442

CPT 11442 refers to the excision of a benign lesion including margins on the face, ears, eyelids, nose, lips, or mucous membrane with a diameter of 1.1 to 2.0 cm. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 11442 procedures.

1. What is CPT 11442?

CPT 11442 is a medical procedure code used to describe the excision of a benign lesion including margins on the face, ears, eyelids, nose, lips, or mucous membrane with a diameter of 1.1 to 2.0 cm. This code is used by medical coders and billers to accurately document and bill for this specific procedure.

2. 11442 CPT code description

The official description of CPT code 11442 is: “Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm.”

3. Procedure

The CPT 11442 procedure involves the following steps:

  1. The patient is taken to the operating room and placed on the surgical table.
  2. The lesion is outlined with a pencil.
  3. The area is washed out with an antiseptic skin solution such as Betadine.
  4. Local anesthetic is applied to make the area insensitive.
  5. The provider incises through the vascular inner layer of skin and carries it down into the level of subcutaneous tissue (fatty layer).
  6. The provider cuts out the lesion in an oval shape with the help of surgical instruments to remove the entire lesion.
  7. The lesion sample is sent to the laboratory for examination.
  8. Blood flow is controlled with electrocautery, taking care not to destroy the tissue framework.
  9. The provider closes the wound in a single layer.

4. Qualifying circumstances

Patients eligible to receive CPT code 11442 services are those with a benign lesion on the face, ears, eyelids, nose, lips, or mucous membrane with a diameter of 1.1 to 2.0 cm. The lesion must be noncancerous and not a skin tag. The excision must be medically necessary and not considered cosmetic. Medical necessity may include lesions that are painful, infected, or causing functional impairment.

5. When to use CPT code 11442

It is appropriate to bill the 11442 CPT code when a provider excises a benign lesion including margins on the face, ears, eyelids, nose, lips, or mucous membrane with a diameter of 1.1 to 2.0 cm. The procedure must be medically necessary and not considered cosmetic. The provider must also perform a simple (nonlayered) closure of the wound.

6. Documentation requirements

To support a claim for CPT 11442, the following information must be documented:

  • Medical necessity for the excision of the lesion
  • Location of the lesion
  • Size of the lesion (diameter)
  • Procedure performed, including the excision and closure
  • Pathology report for the excised lesion

7. Billing guidelines

When billing for CPT code 11442, it is important to follow these guidelines:

  • Ensure that the procedure is medically necessary and not considered cosmetic.
  • Use appropriate modifiers, such as modifier 59 for distinct procedural services when multiple lesions are excised during the same session.
  • Report anatomic modifiers to identify the location of the lesions.
  • Ensure that the documentation supports the claim, including medical necessity, location, size, procedure, and pathology report.

8. Historical information

CPT 11442 was added to the Current Procedural Terminology system on January 1, 1990. The code has undergone the following changes:

  • Code Changed on 01-01-2003: Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm
  • Code Changed on 01-01-2006: Excision, other benign lesion including margins (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm

9. Similar codes to CPT 11442

Five similar codes to CPT 11442 differentiate based on the size of the lesion excised:

  • CPT 11441: Excision of a lesion with a diameter of 0.6 to 1.0 cm
  • CPT 11443: Excision of a lesion with a diameter of 2.1 to 3.0 cm
  • CPT 11444: Excision of a lesion with a diameter of 3.1 to 4.0 cm
  • CPT 11446: Excision of a lesion with a diameter of over 4 cm
  • CPT 11440: Excision of a lesion with a diameter of 0.5 cm or less

10. Examples

Here are 10 detailed examples of CPT code 11442 procedures:

  1. Excision of a 1.5 cm benign lesion on the patient’s nose, including margins and simple closure.
  2. Excision of a 1.2 cm benign lesion on the patient’s upper eyelid, including margins and simple closure.
  3. Excision of a 1.8 cm benign lesion on the patient’s cheek, including margins and simple closure.
  4. Excision of a 1.1 cm benign lesion on the patient’s lower lip, including margins and simple closure.
  5. Excision of a 1.9 cm benign lesion on the patient’s earlobe, including margins and simple closure.
  6. Excision of a 1.3 cm benign lesion on the patient’s forehead, including margins and simple closure.
  7. Excision of a 1.6 cm benign lesion on the patient’s chin, including margins and simple closure.
  8. Excision of a 1.4 cm benign lesion on the patient’s temple, including margins and simple closure.
  9. Excision of a 2.0 cm benign lesion on the patient’s neck, including margins and simple closure.
  10. Excision of a 1.7 cm benign lesion on the patient’s jawline, including margins and simple closure.

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