How To Use CPT Code 11642

CPT 11642 refers to the excision of a malignant lesion, including margins, on the face, ears, eyelids, nose, or lips, with an excised 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 11642 procedures.

1. What is CPT 11642?

CPT 11642 is a medical procedure code used to describe the excision of a malignant lesion, including margins, on the face, ears, eyelids, nose, or lips, with an excised diameter of 1.1 to 2.0 cm. This code is used by medical professionals to accurately document and bill for this specific procedure.

2. 11642 CPT code description

The official description of CPT code 11642 is: “Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 1.1 to 2.0 cm.”

3. Procedure

The CPT 11642 procedure involves the following steps:

  1. Preparation of the area, including cleaning and application of local anesthesia.
  2. Identification and outlining of a margin of healthy tissue around the malignant lesion with a marking pen.
  3. Full-thickness incision through the skin, following the outlined margin.
  4. Excision of the entire lesion, including the previously outlined margins.
  5. Cleaning of all margins and control of bleeding.
  6. Closure of the wound with sutures.
  7. Optional: Sending the excised lesion to a laboratory for further evaluation or performing a frozen section to determine if additional excision of margins is needed.

4. Qualifying circumstances

Patients eligible to receive CPT 11642 services are those with a malignant lesion on the face, ears, eyelids, nose, or lips, with an excised diameter of 1.1 to 2.0 cm. The lesion must be cancerous, such as melanoma, squamous cell carcinoma, or basal cell carcinoma, and locally invasive, with the potential to destroy healthy tissue and metastasize (spread from one body part to another).

5. When to use CPT code 11642

It is appropriate to bill the 11642 CPT code when a provider excises a malignant lesion, including margins, on the face, ears, eyelids, nose, or lips, with an excised diameter of 1.1 to 2.0 cm. The code should be used for accurate documentation and billing of this specific procedure.

6. Documentation requirements

To support a claim for CPT 11642, the following information should be documented:

  • Patient’s medical history and physical examination findings.
  • Diagnosis of the malignant lesion, including type and location.
  • Size of the lesion and excised diameter, including margins.
  • Details of the procedure, including anesthesia, incision, excision, and closure.
  • Any complications or additional procedures performed during the excision.
  • Pathology report, if the excised lesion was sent for further evaluation.

7. Billing guidelines

When billing for CPT code 11642, keep in mind the following guidelines and rules:

  • If multiple lesions of different diameters are excised, apply modifier 59 (Distinct procedural service) to the code for the second lesion.
  • If a second excision on the same lesion area is performed during the global period of the first excision due to positive margins in the pathology report, append modifier 58 (Staged or related procedure) to the second procedure.
  • Use the same malignant diagnosis for the second excision, even if the most recent excision shows no cancer cells in the specimen.

8. Historical information

CPT 11642 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, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 1.1 to 2.0 cm.”

9. Similar codes to CPT 11642

Five similar codes to CPT 11642 differentiate as follows:

  • CPT 11640: Excision of a malignant lesion with an excised diameter of 0.5 cm or less.
  • CPT 11641: Excision of a malignant lesion with an excised diameter of 0.6 to 1.0 cm.
  • CPT 11643: Excision of a malignant lesion with an excised diameter of 2.1 to 3.0 cm.
  • CPT 11644: Excision of a malignant lesion with an excised diameter of 3.1 to 4.0 cm.
  • CPT 11646: Excision of a malignant lesion with an excised diameter of over 4.0 cm.

10. Examples

Here are 10 detailed examples of CPT code 11642 procedures:

  1. Excision of a 1.5 cm diameter melanoma on the patient’s nose, including 0.5 cm margins.
  2. Excision of a 1.2 cm diameter squamous cell carcinoma on the patient’s lower eyelid, including 0.3 cm margins.
  3. Excision of a 1.8 cm diameter basal cell carcinoma on the patient’s cheek, including 0.4 cm margins.
  4. Excision of a 1.1 cm diameter melanoma on the patient’s upper lip, including 0.2 cm margins.
  5. Excision of a 1.9 cm diameter squamous cell carcinoma on the patient’s earlobe, including 0.6 cm margins.
  6. Excision of a 1.3 cm diameter basal cell carcinoma on the patient’s forehead, including 0.3 cm margins.
  7. Excision of a 1.7 cm diameter melanoma on the patient’s chin, including 0.4 cm margins.
  8. Excision of a 1.4 cm diameter squamous cell carcinoma on the patient’s temple, including 0.5 cm margins.
  9. Excision of a 1.6 cm diameter basal cell carcinoma on the patient’s upper eyelid, including 0.2 cm margins.
  10. Excision of a 2.0 cm diameter melanoma on the patient’s cheek, including 0.3 cm margins.

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