Summary & Overview
CPT 11622: Excision of Malignant Skin Lesion, 1.1–2.0 cm, Sensitive Areas
CPT code 11622 represents the excision of malignant skin lesions, including margins, from high-risk anatomical sites such as the scalp, neck, hands, feet, and genitalia, with a lesion diameter between 1.1 and 2.0 cm. This code is widely used in dermatologic surgery to address skin cancers and other malignant growths, ensuring comprehensive removal and optimal patient outcomes. The procedure is most commonly performed in an office setting, reflecting its accessibility and importance in outpatient care.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, provide coverage for services billed under CPT code 11622. This publication offers a detailed overview of payer coverage, clinical benchmarks, and policy updates relevant to this procedure. Readers will gain insights into coding practices, reimbursement trends, and the clinical context for excision of malignant lesions in sensitive areas. The analysis also highlights related CPT codes for excisions of varying lesion sizes, common modifiers used in billing, and associated clinical specialties.
Healthcare professionals, policy analysts, and billing specialists will find this summary useful for understanding the national landscape of CPT code 11622, including payer policies, clinical indications, and coding nuances. The information supports informed decision-making in dermatologic surgery billing and compliance.
CPT Code Overview
CPT code 11622 is used to report the excision of a malignant lesion, including margins, from the scalp, neck, hands, feet, or genitalia, where the lesion diameter measures between 1.1 and 2.0 cm. This procedure falls under dermatologic surgery and is typically performed in an office setting (Place of Service 11). The excision is a critical intervention for the management of skin cancers and other malignant lesions in sensitive anatomical areas, ensuring both removal of the lesion and appropriate margins to reduce recurrence risk.
Clinical & Coding Specifications
Clinical Context
A patient presents to a dermatology clinic with a suspicious skin lesion on the scalp, neck, hand, foot, or genitalia. The lesion has been clinically or histologically confirmed as malignant, such as malignant melanoma or Merkel cell carcinoma. The lesion measures between 1.1 and 2.0 cm in diameter. The provider, typically a dermatologist, family medicine physician, or surgeon, performs an excision of the lesion including appropriate margins to ensure complete removal. The procedure is commonly performed in an office setting (Place of Service 11). Post-excision, the specimen is sent for pathological analysis to confirm clear margins and diagnosis. Documentation includes lesion size, location, diagnosis, and excision details.
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, such as excising multiple lesions at different anatomical sites. -
Modifier
51: Multiple Procedures. Used when more than one procedure is performed during the same session, such as excision of multiple lesions.
| Taxonomy Code | Specialty Name |
|---|---|
207N00000X |