Summary & Overview
CPT 11462: Inguinal Hidradenitis Excision with Closure
CPT code 11462 specifies surgical excision of inguinal skin and subcutaneous tissue for hidradenitis with closure using simple or intermediate repair techniques. This procedure code captures a targeted operative approach for painful, recurrent lesions typically managed surgically when medical therapies are insufficient. Nationally, accurate use of this code supports consistent reporting of ambulatory and outpatient surgical care for a condition that can cause significant morbidity and impact quality of life.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage policies across major payers influence site-of-service selection, prior authorization requirements, and documentation standards for medical necessity.
Readers will find a concise clinical context for the procedure, an outline of payer coverage stakeholders, and guidance on the types of benchmarks and policy considerations relevant to billing and reimbursement. The publication presents typical service settings, common documentation elements required by payers, and comparisons of policy features that affect claim submission and payment. Data not available in the input will be identified explicitly where applicable.
Billing Code Overview
CPT code 11462 describes excision of inguinal skin and subcutaneous tissue involved with hidradenitis, including closure of the excision site using simple or intermediate repair techniques. This procedure targets painful, inflamed lesions associated with sweat glands in the inguinal region.
Service Type: Surgical excision with primary closure.
Typical Site of Service: Ambulatory surgical center or hospital outpatient department; may also be performed in a procedure room within an office setting depending on clinical circumstances and facility capabilities.
Clinical & Coding Specifications
Clinical Context
A 34-year-old patient presents to an outpatient dermatologic surgery clinic with recurrent, painful, and draining nodules in the right inguinal crease consistent with hidradenitis suppurativa. After failed conservative therapy including antibiotics, intralesional corticosteroid injections, and incision and drainage, the dermatologist and surgical team plan a definitive excision of affected inguinal skin and subcutaneous tissue. The procedure is performed in an ambulatory surgery center under local with monitored anesthesia care; the operative note documents excision of diseased tissue, hemostasis, and closure using interrupted and layered simple to intermediate repair techniques. The workflow includes preoperative evaluation and consent, marking the excision boundaries, intraoperative tissue handling and specimen submission if indicated, postoperative dressing, and discharge with wound care instructions and follow-up for suture removal and pathology review.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the work, time, or complexity substantially exceeds typical for 11462 due to extensive disease, fibrosis, or additional dissections documented in the operative note. |
50 | Bilateral procedure | Use when both left and right inguinal areas are excised and payer requires a bilateral modifier instead of separate lines. |
51 | Multiple procedures | Use when 11462 is performed in the same session with other distinct procedures and payer requires a multiple procedure modifier. |
52 | Reduced services | Use when the excision is started but intentionally not completed as described (partial excision) with documentation of reason. |
53 | Discontinued procedure | Use when the procedure is abandoned for extenuating circumstances after anesthesia or prep, documented in intraoperative note. |
59 | Distinct procedural service | Use to indicate a distinct anatomic site or separate procedural service when other procedures are billed on the same date. |
62 | Two surgeons | Use when two surgeons work together as co-surgeons sharing equal responsibility for the excision and closure. |
66 | Surgical team | Use when a surgical team performs the excision with distinct team roles documented. |
78 | Return to OR for related procedure during global period | Use when a related procedure for 11462 is performed in the operating room during the global period for management of a complication. |
79 | Unrelated procedure or service by same physician during global period | Use when an unrelated procedure is performed during the global period (note: not in original modifier list; omit if payer disallows). |
LT | Left side | Use to identify left inguinal excision when side-specific reporting is required. |
RT | Right side | Use to identify right inguinal excision when side-specific reporting is required. |
PT | Data not available in the input. | Data not available in the input. |
QX | Ordering/certifying physician absence | Use when a distinct billing arrangement requires identifying the performing practitioner when ancillary staff performed part of service (per payer policy). |
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Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
L73.2 | Hidradenitis suppurativa | Primary diagnosis indicating chronic inflammatory nodules and sinus tracts in apocrine gland–bearing skin requiring excision such as with 11462. |
L02.91 | Cutaneous abscess, unspecified | Acute abscesses in the inguinal region can coexist with hidradenitis and may necessitate incision/drainage or excision. |
L98.9 | Disorder of skin and subcutaneous tissue, unspecified | Used when a more specific skin disorder is not documented but excision of diseased tissue is performed. |
R22.31 | Localized enlargement of right inguinal lymph nodes | Regional lymphadenopathy may accompany chronic infection/inflammation and is relevant to the clinical picture prompting excision. |
R22.32 | Localized enlargement of left inguinal lymph nodes | See above for contralateral relevance. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
10060 | Incision and drainage of abscess; simple or single | May be performed prior to definitive excision for acute fluctuant abscesses or as an earlier staged procedure in management of hidradenitis. |
12031 | Repair, intermediate, wounds of scalp, arms, and/or legs; 2.6 cm to 7.5 cm | Intermediate repair codes are used when layered closure techniques consistent with the closure described for 11462 are separately reportable by payer policy. |
13131 | Complex repair, forehead, cheeks, and/or chin; 2.6 cm to 7.5 cm | When complex closure techniques beyond simple/intermediate repair are required following wide excision, a complex repair code may be considered if documentation supports it and payer allows. |
11100 | Biopsy of single lesion, trunk, arms or legs; punch | May be performed preoperatively or intraoperatively to sample suspected lesions or to obtain diagnosis prior to wide excision. |
88305 | Pathology; surgical pathology, gross and microscopic examination | Used for microscopic examination of excised tissue from 11462 when specimens are submitted to pathology. |