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The CPT® Code 11626 refers to the excision of a malignant lesion from specific anatomical locations, including the scalp, neck, hands, feet, or genitalia, with an excised diameter exceeding 4.0 cm. This procedure involves the surgical removal of a cancerous growth along with a margin of surrounding healthy tissue to ensure complete excision of the malignancy. Common types of malignant lesions that may be excised using this code include basal cell carcinoma, squamous cell carcinoma, verrucous carcinoma, and melanoma. The process begins with the cleansing of the affected area, followed by the administration of a local anesthetic to minimize discomfort during the procedure. A careful identification of a healthy tissue margin is crucial, as it helps in determining the extent of the incision needed. A full-thickness incision is then made through the dermis, encircling the lesion to facilitate its complete removal. In some cases, a frozen section may be performed during the excision to verify that the margins are free of malignant cells. If any malignant tissue is detected at the margins, additional tissue will be excised until clear margins are achieved. The excised lesion is subsequently sent for histologic evaluation to confirm the diagnosis and assess the margins. To manage any bleeding that may occur during the procedure, electrocautery or chemical cautery techniques are employed. Finally, the surgical wound may be closed using a simple single-layer suture technique, although more complex closure methods such as intermediate (layer) closure, complex repair, skin grafts, or pedicle flaps may also be utilized depending on the specific circumstances of the excision.
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The procedure associated with CPT® Code 11626 is indicated for the excision of malignant lesions located on the scalp, neck, hands, feet, or genitalia. These lesions may include:
The procedure for excising a malignant lesion with CPT® Code 11626 involves several critical steps to ensure the complete removal of the cancerous tissue while preserving surrounding healthy tissue. The first step is to cleanse the area surrounding the lesion thoroughly to reduce the risk of infection. Following this, a local anesthetic is injected to numb the area, ensuring that the patient experiences minimal discomfort during the procedure. Once the area is adequately anesthetized, the surgeon identifies a margin of healthy tissue around the lesion, which is essential for ensuring that all malignant cells are removed. A full-thickness incision is then made through the dermis, encircling the lesion. This incision is carefully executed to ensure that the entire lesion, along with the designated margin of healthy tissue, is excised in one piece. In some cases, a frozen section may be performed during the excision to assess the adequacy of the margins. If malignant cells are detected at the margins, the surgeon will excise additional tissue until clear margins are confirmed. After the lesion is completely removed, it is sent to the laboratory for histologic evaluation, which is crucial for determining the nature of the lesion and ensuring that it has been fully excised. During the procedure, any bleeding that occurs is controlled using electrocautery or chemical cautery techniques. Finally, the surgical wound is typically closed using a simple single-layer suture technique; however, depending on the complexity of the excision and the size of the wound, alternative closure methods such as intermediate (layer) closure, complex repair, skin grafts, or pedicle flaps may be employed.
After the excision procedure is completed, the patient will be monitored for any immediate complications, such as excessive bleeding or infection. Post-procedure care typically includes instructions for wound care, which may involve keeping the area clean and dry, changing dressings as directed, and watching for signs of infection such as increased redness, swelling, or discharge. Patients may also be advised to avoid strenuous activities that could stress the surgical site during the initial healing period. Follow-up appointments are essential to assess the healing process and to discuss the results of the histologic evaluation of the excised tissue. Depending on the findings, further treatment may be necessary if any malignant cells are detected at the margins or if additional concerns arise from the histologic analysis.
| Short Descr | EXC S/N/H/F/G MAL+MRG >4 CM | Medium Descr | EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM | Long Descr | Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm | Status Code | Active Code | Global Days | 010 - Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5A - Ambulatory procedures - skin | MUE | 2 | CCS Clinical Classification | 170 - Excision of skin lesion |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | GC | This service has been performed in part by a resident under the direction of a teaching physician | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 74 | Discontinued out-patient hospital/ambulatory surgery center (asc) procedure after administration of anesthesia: due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc). under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of modifier 74. note: the elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. for physician reporting of a discontinued procedure, see modifier 53. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AG | Primary physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CG | Policy criteria applied | CR | Catastrophe/disaster related | F1 | Left hand, second digit | F2 | Left hand, third digit | F5 | Right hand, thumb | F6 | Right hand, second digit | F7 | Right hand, third digit | F8 | Right hand, fourth digit | GA | Waiver of liability statement issued as required by payer policy, individual case | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | LT | Left side (used to identify procedures performed on the left side of the body) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) | SG | Ambulatory surgical center (asc) facility service | TA | Left foot, great toe | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2013-01-01 | Changed | Description Changed |
| 2003-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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