Summary & Overview
CPT 11470: Excision for Hidradenitis, Perianal/Perineal/Umbilical
CPT code 11470 represents surgical excision of perianal, perineal, or umbilical skin and subcutaneous tissue involved with hidradenitis, with closure using simple or intermediate repair. Nationally, this code captures procedures addressing painful, recurrent lesions in intertriginous areas where hidradenitis can cause significant morbidity and impair quality of life. Accurate coding supports clinical tracking, appropriate payment, and care coordination for a condition that often requires multidisciplinary management.
Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a national perspective on billing and clinical context for 11470, including common service settings, documentation points tied to the procedure description, and how the code fits within procedural coding for skin and subcutaneous excisions.
Readers will find benchmark-oriented content on utilization patterns and payer coverage considerations, summaries of relevant policy updates where available, and clinical context to inform coding and administrative workflows. The content is aimed at billing managers, clinicians, and policy analysts seeking concise guidance on the clinical intent of 11470, typical sites of service, and the payer landscape affecting reimbursement and claim adjudication. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 11470 describes excision of perianal, perineal, or umbilical skin and subcutaneous tissue involved with hidradenitis, with closure of the excision site using simple or intermediate repair techniques. The procedure is targeted at painful, recurrent lesions associated with hidradenitis affecting areas where sweat glands are involved.
Service type: Surgical excision with closure (simple or intermediate repair).
Typical site of service: Ambulatory surgical center or hospital outpatient department; may also be performed in a procedural suite within a dermatology or general surgery clinic depending on facility capabilities and patient needs.
Clinical & Coding Specifications
Clinical Context
A 34-year-old patient presents to a general surgery clinic with recurrent, painful nodules and sinus tracts in the perianal/perineal area consistent with hidradenitis suppurativa refractory to conservative management. The patient has had multiple flares with localized cellulitis and abscess formation despite oral antibiotics, incision and drainage, and topical therapy. After preoperative evaluation including history, focused physical exam, and informed consent, the surgeon schedules an excision of affected skin and subcutaneous tissue under monitored anesthesia care. Intraoperatively, the surgeon excises the diseased perianal/perineal skin and subcutaneous tissue and performs a simple or intermediate layered closure of the excision site. The procedure occurs in an outpatient surgical center or hospital minor procedure suite with standard sterile technique. Postoperative workflow includes wound care instructions, prescription analgesia, follow-up visit for wound check and suture removal, and documentation of operative site, size of excision, closure technique, anesthesia type, and any complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, and complexity substantially exceed usual for 11470. |