How To Use cpt 11604

cpt 11604 describes the excision of a malignant lesion, including margins, with a diameter of 3.1 to 4.0 cm from the skin of the trunk, arms, or legs. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of cpt 11604.

1. What is cpt 11604?

cpt 11604 is a code used to describe the excision of a malignant lesion, including margins, with a diameter of 3.1 to 4.0 cm from the skin of the trunk, arms, or legs. This procedure involves the removal of cancerous tissue along with a margin of healthy tissue to ensure complete removal of the lesion. It is typically performed by a healthcare provider after appropriate preparation and local anesthesia.

2. Official Description

The official description of cpt 11604 is: ‘Excision, malignant lesion including margins, trunk, arms, or legs excised diameter 3.1 to 4.0 cm.’

3. Procedure

The procedure for cpt 11604 involves several steps:

1. The healthcare provider prepares the patient and administers local anesthesia to numb the area.
2. A margin of healthy tissue is identified and outlined with a marking pen.
3. The provider makes a full-thickness incision through the skin, encompassing the entire lesion and the previously outlined margins.
4. All margins are cleaned and bleeding is controlled.
5. The wound is closed with sutures.
6. If necessary, the excised lesion may be sent to a laboratory for further evaluation or a frozen section may be performed to determine if additional excision of margins is required.

4. Qualifying circumstances

cpt 11604 is used for the excision of malignant lesions with a diameter of 3.1 to 4.0 cm from the skin of the trunk, arms, or legs. These lesions can include melanoma, squamous cell carcinoma, or basal cell carcinoma. The procedure is performed when the lesion is locally invasive and has the potential to spread and cause harm if left untreated.

5. When to use cpt code 11604

cpt 11604 should be used when a healthcare provider performs the excision of a malignant lesion, including margins, with a diameter of 3.1 to 4.0 cm from the skin of the trunk, arms, or legs. It is important to accurately document the size of the lesion and ensure that it falls within the specified diameter range for this code.

6. Documentation requirements

To support a claim for cpt 11604, the healthcare provider must document the following information:

• The diagnosis of a malignant lesion
• The size of the lesion, including the diameter
• The location of the lesion (trunk, arms, or legs)
• The use of local anesthesia
• The identification and outlining of margins
• The full-thickness incision and removal of the lesion
• The closure of the wound with sutures
• Any additional procedures performed, such as a frozen section or further excision of margins

7. Billing guidelines

When billing for cpt 11604, it is important to ensure that the documentation supports the use of this code. The procedure should be performed by a qualified healthcare provider and the lesion should meet the specified criteria. It is also important to follow any additional guidelines provided by the payer or coding guidelines.

8. Historical information

cpt 11604 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Similar codes to cpt 11604

There are several similar codes to cpt 11604 that describe excision procedures for malignant lesions of different sizes and locations. Some examples include:

• cpt 11600: Excision, malignant lesion including margins, trunk, arms, or legs excised diameter 0.5 cm or less
• cpt 11601: Excision, malignant lesion including margins, trunk, arms, or legs excised diameter 0.6 to 1.0 cm
• cpt 11602: Excision, malignant lesion including margins, trunk, arms, or legs excised diameter 1.1 to 2.0 cm
• cpt 11603: Excision, malignant lesion including margins, trunk, arms, or legs excised diameter 2.1 to 3.0 cm
• cpt 11606: Excision, malignant lesion including margins, trunk, arms, or legs excised diameter over 4.0 cm

9. Examples

1. A healthcare provider performs the excision of a 3.5 cm malignant lesion, including margins, from the trunk of a patient.
2. A surgeon removes a 4.0 cm malignant lesion, including margins, from the leg of a patient.
3. A dermatologist excises a 3.2 cm malignant lesion, including margins, from the arm of a patient.
4. A plastic surgeon performs the excision of a 3.8 cm malignant lesion, including margins, from the leg of a patient.
5. An oncologist removes a 3.6 cm malignant lesion, including margins, from the trunk of a patient.
6. A general surgeon excises a 3.3 cm malignant lesion, including margins, from the arm of a patient.
7. A dermatologist performs the excision of a 3.9 cm malignant lesion, including margins, from the leg of a patient.
8. A plastic surgeon removes a 3.7 cm malignant lesion, including margins, from the trunk of a patient.
9. An oncologist excises a 3.4 cm malignant lesion, including margins, from the arm of a patient.
10. A general surgeon performs the excision of a 3.1 cm malignant lesion, including margins, from the leg of a patient.