11642

Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 1.1 to 2.0 cm

CPT code 11642 describes the surgical excision of a malignant skin lesion, including its margins, located on the face, ears, eyelids, nose, or lips. This procedure is specifically designated for cases where the excised diameter measures between 1.1 cm and 2.0 cm. The 'excised diameter' is a critical metric calculated by taking the longest clinical diameter of the lesion and adding twice the width of the narrowest margin required for complete surgical clearance. This code represents a full-thickness removal, meaning the incision extends through the epidermis and dermis into the subcutaneous fat layer. The anatomical areas covered by this code—face, ears, eyelids, nose, and lips—are considered highly sensitive and complex due to their functional and aesthetic importance. Consequently, these areas require precise surgical technique to ensure oncological safety while preserving structure. The procedure involves marking the lesion and the planned surgical margins, administering local anesthesia, performing the excision, and potentially undermining the surrounding tissue to facilitate closure. If the resulting defect is repaired using a simple closure (suturing the skin edges together without significant undermining), the closure is considered bundled into 11642. However, if the clinical situation necessitates intermediate or complex closure, those services may be reported separately using the appropriate repair codes (12031-12057 or 13131-13153). Pathological examination of the excised specimen is an inherent component of the post-operative process to confirm malignancy and clear margins.

Clinical Indications

  • Confirmed primary or recurrent malignant neoplasm of the skin (e.g., Basal Cell Carcinoma, Squamous Cell Carcinoma)
  • Melanoma in situ where narrow margins are clinically appropriate
  • Lesion exhibiting high-risk clinical features for malignancy on the face, ears, or nose
  • Malignant adnexal tumors of the skin
  • Dermatofibrosarcoma protuberans (DFSP) or other cutaneous sarcomas

Procedure Steps

  1. Verify patient identity and surgical site through a standard 'time-out' procedure.
  2. Cleanse the surgical field with an antiseptic solution and drape in a sterile fashion.
  3. Clinically delineate the malignant lesion and mark the surgical margins using a surgical pen.
  4. Measure the total excised diameter (longest lesion diameter + margins) to ensure correct CPT code selection.
  5. Infiltrate the area with local anesthetic (e.g., lidocaine with epinephrine).
  6. Perform a full-thickness incision through the dermis into the subcutaneous tissue using a scalpel.
  7. Undermine or dissect the lesion away from underlying structures to ensure complete removal.
  8. Achieve hemostasis using electrocautery or pressure.
  9. Submit the specimen in formalin for histopathological evaluation to confirm malignancy and margin status.
  10. Perform a simple closure (if applicable) or prepare the wound for intermediate/complex repair.
  11. Apply a sterile dressing to the surgical site.

Coding Guidelines

  • Selection of code 11642 is based on the 'excised diameter' (longest lesion diameter plus margins), not the specimen size after shrinkage in formalin.
  • Measurements must be taken and documented prior to the excision.
  • Simple closure (12001-12021) is included in 11642 and should not be reported separately.
  • Intermediate (12031-12057) or complex (13100-13153) repairs may be reported separately if performed.
  • Adjacent tissue transfer or rearrangement (14000-14302) includes the lesion excision and should not be reported with 11642.
  • If the lesion is benign, use the 1144x series instead of 116xx.
  • Append modifier 59 (Distinct Procedural Service) if multiple lesions are excised during the same session to indicate different anatomical sites.
  • Malignancy must be confirmed either by prior biopsy or by the pathological results of the current excision.

Associated ICD-10 Codes