Summary & Overview
CPT 11404: Excision of Benign Skin Lesion, Trunk/Arms/Legs 3.1–4.0 cm
CPT code 11404 represents the surgical excision of a noncancerous skin lesion (excluding skin tags) measuring 3.1 to 4.0 cm in diameter, including margins, from the trunk, arms, or legs. This code is widely used in outpatient dermatologic and general surgical practice and is important for accurate capture of operative complexity, resource utilization, and quality measurement for minor skin surgery. Nationally, correct coding of lesion size and anatomical site affects payment, clinical documentation, and comparative utilization reporting.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of the clinical circumstances that map to this code, common sites of service, and the typical service type. The publication provides benchmarks and coding guidance context such as relative service complexity and expected use in outpatient surgical settings, and it highlights policy-relevant points affecting reimbursement and documentation. Data not available in the input regarding associated taxonomies, specific ICD-10 pairings, or payer-specific edits will be identified as missing. This summary is intended for national audiences including coding professionals, clinicians, and policy analysts seeking a clear, practice-focused overview of CPT code 11404.
Billing Code Overview
CPT code 11404 describes the excision of a benign skin lesion (excluding skin tag) with a diameter of 3.1 to 4.0 cm, including margins, from the skin of the trunk, arms, or legs. This procedure entails surgical removal of a noncancerous lesion with appropriate margins to ensure complete excision.
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Service type: Surgical excision of benign skin lesion
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Typical site of service: Outpatient surgical setting, ambulatory surgical center, or hospital outpatient department where minor dermatologic surgery is performed
Clinical & Coding Specifications
Clinical Context
A 56-year-old man presents to a dermatology clinic with a progressively enlarging, nonpigmented, painless soft tissue lesion on the lateral thigh. Clinical exam measures the lesion at approximately 3.5 cm in greatest diameter. The lesion appears benign on visual inspection and handheld dermoscopy; the provider plans an excisional biopsy for definitive diagnosis and symptomatic relief. The patient is prepped in a procedure room within the outpatient dermatology clinic. After informed consent, local anesthesia (e.g., 1% lidocaine with epinephrine) is administered, and the surgeon excises the lesion with margins, achieving a total specimen diameter between 3.1 and 4.0 cm. Hemostasis is obtained, layered closure is performed, and the specimen is sent to pathology for histologic evaluation. The clinical workflow includes pre-procedure documentation of lesion size and location, consent, administration of local anesthesia, performance of the excision, specimen handling and labeling, operative note documentation with measurements and closure details, and postoperative instructions. Typical site of service is an outpatient dermatology or ambulatory surgery center. The service type is a minor surgical excision of a benign cutaneous lesion on the trunk, arms, or legs documented as 11404.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct Procedural Service | When another procedure at a separate anatomic site or a distinct surgical service is performed that is not usually reported together. |
25 | Significant, Separately Identifiable Evaluation and Management Service | When a significant E/M is performed and documented on the same day as the excision. |
50 | Bilateral Procedure | When the same excision is performed bilaterally and payer accepts bilateral modifier coding for dermatologic services. |
52 | Reduced Services | When the service is partially reduced or not completed as originally planned. |
53 | Discontinued Procedure | When the procedure is started but discontinued due to extenuating circumstances. |
22 | Increased Procedural Services | When work required is substantially greater than typically required for 11404 and well documented. |
RT | Right Side | When the excision is on the right side and laterality must be reported. |
LT | Left Side | When the excision is on the left side and laterality must be reported. |
26 | Professional Component | If billing split between professional and technical components for pathology interpretation (rare for excision billing context). |
TC | Technical Component | For the technical component of a diagnostic service associated with the procedure (e.g., pathology processing billed by the lab). |
57 | Decision for Surgery (not in provided list) | Data not available in the input. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207N00000X | Dermatology | Most common specialty performing skin excisions on trunk/limbs. |
208000000X | General Surgery | Performs excisions for larger or deep lesions on trunk/arms/legs. |
207K00000X | Plastic Surgery | Performs excisions requiring complex closure or reconstructive techniques. |
2086S0123X | Family Medicine | Performs minor skin excisions in outpatient clinic settings. |
2084P0800X | Surgical Oncology | Performs excisions when lesion suspicion for neoplasm is higher. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
L02.415 | Cutaneous abscess of right thigh | Demonstrates an infectious lesion that may require excision and drainage rather than simple biopsy. |
L98.9 | Disorder of skin and subcutaneous tissue, unspecified | Used when a specific benign lesion diagnosis is not yet established prior to pathology. |
D23.6 | Other benign neoplasm of skin of upper limb, including shoulder | Common benign lesion diagnosis for excisions on the arm. |
D23.5 | Other benign neoplasm of skin of trunk | Common benign lesion diagnosis for trunk excisions. |
L91.8 | Other hypertrophic disorders of skin | May be used for noncancerous growths requiring excision for symptomatic or cosmetic reasons. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
11400 | Excision, benign lesion including margins; 0.5 cm or less | Smaller-size excisions; used when lesion size falls below 11404 range. |
11402 | Excision, benign lesion including margins; 1.1 to 2.0 cm | Used for lesions smaller than the 11404 size range in the same anatomic sites. |
11646 | Excision, malignant lesion including margins; trunk, arms or legs; lesion diameter over 4.0 cm | Used when pathology confirms malignancy or clinical suspicion warrants malignant excision coding for larger lesions. |
12032 | Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities; 2.6 cm to 7.5 cm | Used for layered intermediate closure when the repair complexity of the excision requires a separate repair code. |
88305 | Level IV pathology, surgical pathology, gross and microscopic examination | Common pathology code for specimen processing and microscopic evaluation following excision. |