CPT For Lipoma Excision (2022) – Descriptions, Guidelines, Reimbursement, Modifiers & Examples
CPT for lipoma excision may be coded as the lipoma removal to the excision of a benign lesion.
The appropriate codes are CPT 11400 – CPT 11446, depending on the size and extent of the lipoma terminated. As per the description, it is the excision of benign lesions from the specific site of the body depending upon diameter.
CPT For Lipoma Excision Description
A lipoma is a fatty tumor. However, this does not always signify a cancerous growth, as evidenced here since lipomas are just a tumor of adipose tissue.
A lipoma defines as a benign tumor formed of fat cells. It may present in the subcutaneous tissue, dermis, epidermis, and sometimes below the fascia (i.e., subfascial and sub-muscular).
Coding selection should depend on the area and the precise deepness of the lipoma. For example, most lesions are under the dermis but beyond the fascia.
Suppose the physician has not specified the location of the lesion. The codes for these procedures should come from the Integumentary section of the CPT Manual.
Alternatively, suppose the documentation indicates the lesion was below the fascia. The code description may suggest that the physician removes a “soft tissue lesion,” and the coder may find the CPT code under the specific anatomic location. If the lipoma is present superficially, the coder may code it CPT for lipoma excision of a benign lesion.
Usually, the physician can easily remove entire lipomas by dissecting them using scissors or a scalpel from the surrounding tissue.
Once he examines a portion of lipoma from the surrounding tissue, hemostats or clamps are ready for attachment to the tumor to provide traction for removal of the remainder of the growth.
Sometimes the lipoma may have elongations or projections (finger-like) that twist around other systems like nerves. It makes the removal more complicated.
The provider can remove more giant lipomas through incisions made in the skin overlying the lipoma. The incisions are configured like a fusiform excision following the skin tension lines and are smaller than the underlying tumor.
Regardless of the removal, it is essential to have a size provided by the surgeon so that the coder may choose an appropriate code. Size depends on the greatest diameter of the lesion plus any margin, just like for lesion removals.
The excision approach of lesions (benign) on the skin has procedural codes from CPT 11400 to CPT 11446:
Employ CPT 11400 – 11406 for excision in arms, legs, or trunk.
Employ CPT 11420 – 11426 for neck, scalp, feet, genitalia, and hands.
Employ CPT 11440 – 11446 for ears, nose, face, eyelids, mucous membrane, and lips.
The excision approach of lesions (malignant) on the skin has procedural codes from CPT 11600 to CPT 11646:
Employ CPT 11600 – 11606 for arms, legs, or trunk.
Employ CPT 11620 – 11626 for neck, scalp, feet, genitalia, and hands.
Employ CPT 11640 – 11646 for ears, nose, face, eyelids, mucous membrane, and lips.
CPT For Lipoma Excision Billing Guidelines & Reimbursement Policy
Lipomas arise at any site of the body. However, lipomas primarily emerge on the trunk, shoulders, back, arms, and neck.
When they appear below the enclosing fascia, they are called deep-seated lipomas. Infrequently, lipomas can arise inside the muscle and are called intramuscular lipomas.
Private payers will cover the removal of lipomas when medically necessary is there and when the provider has documented the lesion is causing functional impairment. Functional impairment defines as the pain of such magnitude or locations of the tumor.
The documentation is significant because people with lipomas have several in many sites. Unfortunately, not all of them meet the criteria for medical necessity.
If there is no functional impairment, removing a lipoma is not covered based on the cosmetic exclusion in the certificate of coverage.
To select the suitable CPT for removing lipoma, one must understand the different layers of skin:
The first layer is Epidermis – The split-thickness between the epidermis and dermis.
The 2nd layer is Dermis – Full-thickness of the epidermis and the entire dermis.
The 3rd layer is Subcutaneous – Below the dermis, meaning fat and connective tissues.
Suppose the lipoma is present in the epidermis or dermis (natural skin). The coder may use the codes from an integumentary system. These are appropriate CPT for lipoma excision codes.
For excision in arms, legs, or trunk:
CPT 11400 – excision of lesion (benign); 0.5 cm or less
CPT 11401 – excision of lesion (benign); 0.6 to 1.0 cm
CPT 11402 – excision of lesion (benign); 1.1 to 2.0 cm
CPT 11403 – excision of lesion (benign); 2.1 to 3.0 cm
CPT 11404 – excision of lesion (benign); 3.1 to 4.0 cm
CPT 11406 – excision of lesion (benign); 4.0 cm
For neck, scalp, feet, genitalia, and hands:
CPT 11420 – excision of lesion (benign); 0.5 cm or less
CPT 11421 – excision of lesion (benign); 0.6 to 1.0 cm
CPT 11422 – excision of lesion (benign); 1.1 to 2.0 cm
CPT 11423 – excision of lesion (benign); 2.1 to 3.0 cm
CPT 11424 – excision of lesion (benign); 3.1 to 4.0 cm
CPT 11426 – excision of lesion (benign); 4.0 cm
For ears, nose, face, eyelids, mucous membrane:
CPT 11440 – excision of lesion (benign); 0.5 cm or less
CPT 11441 – excision of lesion (benign); 0.6 to 1.0 cm
CPT 11442 – excision of lesion (benign); 1.1 to 2.0 cm
CPT 11443 – excision of lesion (benign); 2.1 to 3.0 cm
CPT 11444 – excision of lesion (benign); 3.1 to 4.0 cm
CPT 11446 – excision of lesion (benign); 4.0 cm
The coder may choose code by studying the pathology reports confirming Morphology (benign or malignant, or uncertain), technique, topography (anatomic location), size, tissue Level, and type of closure required.
If the physician seems necessary for re-excision, keep an eye on the global days for the procedure. An excision is a minor method and carries a 10 – day global period.
Any post-operative procedures are included and generally are not payable for ten days. The coder may report each lesion separately.
If provider adjacent tissue transfer is required, only report the tissue transfer CPT 14000 – CPT 14302. Use CPT 11400 – CPT 11646 for complete CPT for lipoma excision.
If the physician performs a repair by intermediate or complex closure, one may bill it separately. Code range CPT 21011 – CPT 21016 provides the CPT for lipoma excision codes for soft tissue tumors subcutaneous and subfascial on the face or scalp.
Suppose services need a referring/ordering doctor. In that case, the coder or biller must report the name and NPI of the referring/ordering physician on the claim.
The insurance companies may return the bill as an incomplete claim if one submits it without a valid ICD – 10 CM. The provider may use an ABN (Advance Beneficiary Notice) for services that are likely to be noncovered, whether for medical necessity or other reasons. Effective April 1, 2010, one should bill noncovered services with an appropriate modifier GA, GX, GY, or GZ.
For excision of benign lesions requiring more than simple closure, i.e., requiring intermediate or complex closure, report CPT 11400 – CPT 11466 in addition to appropriate intermediate (CPT 12031 – CPT 12057) or difficult closure (CPT 13100 – CPT 13153) codes. For reconstructive closure, the coder must go through CPT codes 14000 – 14300, 15000 – 15261, and 15570 – 15770.
One must bill all services/procedures performed on the same day for the same beneficiary by the physician/provider on the same claim. The documents required are: medical history, assessment report by the provider, chief complaints of the patient, lab reports, signed operative report, and signed office visit report. The type of removal is at the treating physician’s discretion.
Not all indications represent a specific diagnosis, but maybe conditions support a diagnosis. For example, suppose the provider excises a lesion because of suspicion of malignancy. The medical record might comprise of “increase in size” to support the diagnosis. “Increase in size” might also assist the diagnosis of the commotion of skin sensation.
Use modifier 58 for re-excision within the post-op period. Use Modifier 59 for CPT for lipoma excision in the exact area but is different or unrelated to the other service.
Use Modifier 51 for Multiple procedures (Medicare does not need Modifier 51). Use modifier 24 for the same physician’s unrelated evaluation and management services during a global post-operative period.
Use modifier 25 when the physician performs separately identifiable evaluation and management services that are above and beyond the pre-and post-operative work of the procedure by the same physician on the same day.
E&M services given on the same day, or provided on the day before a minor surgical procedure, to decide to perform the method are not payable. In addition, please do not use the modifier 57 since insurance considers it a routine preoperative service. (Modifier 57 is only applicable for effective techniques within a 90 – day global period)
Use the GY modifier when practitioners need to demonstrate that the service is noncovered or is not in the benefit of Medicare. Use GA modifier when practitioners need to show that they predict that Medicare will reject a standard service as not reasonable and necessary.
They have signed notice (ABN) by the beneficiary. Use modifier GA when insurance denies benefits under appropriate and essential provisions. The beneficiary should sign an ABN to show that they bear responsibility for payment. The coder may also use a GA modifier for claims when a patient denies inscribing the notice.
Use modifier GX when the beneficiary has signed an ABN. The practitioners predicted a denial depending upon provisions other than necessity (medial), such as legal exclusions of scope or specialized cases.
Use GZ modifier when practitioners require to reveal that they indicated that Medicare might deny service as not valid and needed. For example, they do not have a signed notice (ABN).
A 37 years old female came to visit the physician for pain in her right lower arm at a specific site. The area had swollen, and she had had this pain for the last two months.
As per a physical examination, the physician expected a lipoma. So, the physician ordered radiological analysis. The reports showed that she had a lipoma of 3.5 cm located superficially.
The physician then removed the lipoma. The lipoma had no projections.
The coder may select the CPT code from the integumentary system, i.e., CPT 11400 – CPT 11446. Depending upon the site and size of the lipoma, the coder must choose CPT 11404.