Summary & Overview
CPT 11423: Excision of Benign Skin Lesion 2.1–3.0 cm
CPT code 11423 denotes the surgical excision of a benign (noncancerous) skin lesion, excluding skin tags, when the lesion measures 2.1 to 3.0 cm in diameter including margins and is located on the scalp, neck, hands, feet, or genitals. This code is used to classify a common outpatient dermatologic procedure with implications for surgical coding accuracy, payer coverage determinations, and clinical documentation standards. Accurate use of this code affects claims processing, utilization tracking, and quality reporting across national payers.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The discussion addresses payer coverage considerations and typical billing contexts for outpatient excisions of benign lesions, highlighting where documentation must support lesion size and anatomical site.
Readers will find concise benchmarks for coding practice, an overview of the clinical context for the procedure, and notes on common billing considerations such as service setting and lesion characteristics. Data not available in the input is explicitly noted where applicable. The content is intended for national audiences involved in clinical documentation, coding, revenue cycle management, and policy oversight.
Billing Code Overview
CPT code 11423 describes the excision of a noncancerous skin lesion (excluding a skin tag) measuring 2.1 to 3.0 cm in diameter, including margins, when removed from the scalp, neck, hands, feet, or genitals. This procedure is a straightforward surgical excision of a benign cutaneous lesion and typically involves local excision with appropriate margins for complete removal.
Service Type: Excision of benign skin lesion (simple surgical procedure)
Typical Site of Service: Outpatient surgical setting or office-based procedure room, with the lesion located on the scalp, neck, hands, feet, or genital area.
Clinical & Coding Specifications
Clinical Context
A 54-year-old patient presents to a dermatology clinic with a slowly enlarging, noncancerous (benign) cutaneous lesion on the dorsal hand that measures approximately 2.5 cm in greatest diameter including margins. The lesion is symptomatic with intermittent tenderness and has cosmetic concern. After clinical evaluation and discussion of risks and benefits, the dermatologist schedules an outpatient excision. On the day of service, the patient is prepared in a procedure room; local anesthesia (lidocaine with epinephrine) is administered, standard sterile technique is used, and the provider excises the lesion with a 2.5 cm total diameter specimen including margins. Hemostasis is achieved with cautery, a layered closure is performed, and dressings applied. Tissue is submitted to pathology if indicated. The service is billed using 11423 for excision of a benign lesion, 2.1–3.0 cm, from a site included in the code description (hand). Typical site of service is an outpatient dermatology office or ambulatory surgical center. Common clinical workflow steps include pre-procedure evaluation and consent, local anesthesia administration, lesion excision with margin, wound closure, immediate post-procedure instructions, and pathology processing if submitted. Documentation should include lesion location, size (including margins), procedure details, anesthesia, closure technique, and follow-up plan.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure |