11403

Excision, Benign Lesion including Margins, Trunk, Arms, or Legs; Excised Diameter 2.1 to 3.0 cm

CPT code 11403 represents the surgical excision of a benign lesion from the skin of the trunk, arms, or legs, where the total diameter of the excision (including the lesion and necessary margins) measures between 2.1 cm and 3.0 cm. This procedure involves a full-thickness removal of the lesion, extending through the dermis and potentially into the subcutaneous fat. Benign lesions commonly treated under this code include melanocytic nevi (moles), sebaceous cysts, epidermal inclusion cysts, dermatofibromas, and symptomatic lipomas. The process begins with the physician measuring the lesion at its widest point and then determining the narrowest margin required to adequately remove the growth. This total dimension—the diameter of the lesion plus the margins—must be documented as the 'excised diameter' to justify the selection of code 11403. The procedure is usually performed under local anesthesia in an outpatient or office setting. After achieving a sterile field, the surgeon makes a fusiform or elliptical incision to facilitate the removal and subsequent primary closure. Hemostasis is typically managed via electrocautery or chemical agents. This code specifically includes simple (non-layered) closure. If the excision requires a more complex repair, such as intermediate (layered) or complex closure, those repairs should be reported separately using the appropriate codes from the 12031-13160 range. The specimen removed is almost always sent for histopathological analysis to confirm its benign nature and ensure that no malignant cells are present, although the pathology service itself is coded separately.

Clinical Indications

  • Presence of a benign melanocytic nevus showing signs of irritation or inflammation.
  • Symptomatic epidermal inclusion cyst or sebaceous cyst that is frequently infected or causing discomfort.
  • Dermatofibroma that is painful or aesthetically distressing to the patient.
  • Superficial lipoma on the limbs or trunk that restricts movement or causes pain.
  • Atypical looking skin lesion where a full-thickness excision is required to rule out malignancy despite benign clinical appearance.
  • Persistent or enlarging benign skin neoplasm that does not respond to conservative management.
  • Benign skin growth located in an area subject to chronic friction or trauma.

Procedure Steps

  1. The surgical site on the trunk, arm, or leg is identified and confirmed with the patient.
  2. The lesion is measured at its widest diameter, and the surgical margins are marked to determine the total excised diameter.
  3. The area is prepped with an antiseptic solution (e.g., chlorhexidine or povidone-iodine) and draped to maintain sterility.
  4. Local anesthesia, such as 1% lidocaine with epinephrine, is infiltrated around and beneath the lesion.
  5. A full-thickness incision is made along the marked margins, typically in an elliptical shape to allow for optimal wound edge apposition.
  6. The lesion is carefully dissected from the underlying subcutaneous tissue using a scalpel or surgical scissors.
  7. Hemostasis is achieved through the use of electrocautery, pressure, or suture ligation of small vessels.
  8. The surgical defect is closed using a simple, single-layer suture technique (if layered closure is not required).
  9. The wound is cleansed, and a sterile dressing or bandage is applied.
  10. The excised specimen is placed in a formalin container and labeled for transport to the pathology laboratory.

Coding Guidelines

  • Selection of the correct code is based on the 'excised diameter,' which is the widest diameter of the lesion plus the narrowest margins required.
  • Measurements must be taken and documented prior to the excision, as tissue shrinkage occurs once the specimen is removed and placed in fixative.
  • Code 11403 is specific to the trunk (including the neck), arms, and legs. Excisions on the face, scalp, or hands/feet use different code series (1142x or 1144x).
  • Simple closure is included in the 11403 procedure and is not reported separately.
  • Intermediate closure (12031-12037) or complex closure (13100-13153) may be reported in addition to the excision code if documented.
  • If the lesion is determined to be malignant by pathology, the 11600-11646 series should be used instead of 11400-11446.
  • Multiple excisions of different lesions should be reported separately, often requiring modifier 59 to indicate distinct procedural services.
  • Do not use this code for the removal of skin tags (use 11200-11201) or for shave removals (use 11300-11313).

Associated ICD-10 Codes