Summary & Overview
CPT 11604: Excision of Malignant Skin Lesion, Trunk/Arms/Legs, 3.1-4.0 cm
CPT code 11604 represents the excision of a malignant skin lesion, including margins, on the trunk, arms, or legs, with a diameter between 3.1 cm and 4.0 cm. This procedure is a critical component in the management of skin cancers, particularly melanoma, and is frequently performed in both office and hospital outpatient settings. Nationally, this code is recognized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare, making it relevant for a wide range of providers and patients.
This publication provides a comprehensive overview of 11604, covering payer coverage, clinical context, and related coding benchmarks. Readers will gain insight into policy updates, typical sites of service, and the role of this code in dermatology and procedural skin surgery. The summary also highlights associated modifiers and taxonomies, as well as relevant ICD-10 diagnoses and related CPT codes, offering a clear understanding of how 11604 fits within broader billing and clinical workflows. The information is designed to support healthcare professionals, administrators, and policy analysts in navigating the complexities of medical billing and coding for malignant skin lesion excision.
CPT Code Overview
CPT code 11604 is used to report the excision of a malignant skin lesion, including margins, on the trunk, arms, or legs, where the excised diameter measures between 3.1 cm and 4.0 cm. This procedure falls under the category of surgical procedures on the skin and is commonly performed in an office setting (Place of Service 11) or in a hospital outpatient facility (Place of Service 19 or 22). The code is integral for documenting and billing the removal of skin cancers in these anatomical regions, ensuring accurate representation of the clinical service provided.
Clinical & Coding Specifications
Clinical Context
A patient presents to a dermatology clinic with a suspicious skin lesion on the trunk, arm, or leg. After clinical evaluation and possible biopsy, the lesion is diagnosed as malignant, such as malignant melanoma. The provider determines that surgical excision is necessary, and the lesion measures between 3.1 cm and 4.0 cm in diameter, including margins. The procedure is performed in an office or hospital outpatient setting. The excision is documented, and the specimen is sent for pathology. Post-procedure, wound closure may be performed, and follow-up is scheduled to monitor healing and recurrence.
Coding Specifications
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Modifier
59: Distinct Procedural Service. Used when a procedure or service is distinct or independent from other services performed on the same day. -
Modifier
51: Multiple Procedures. Used when multiple procedures are performed during the same session by the same provider.
| Modifier Code | Description |
|---|---|
59 | Distinct Procedural Service |