Overview of CPT Code 11426: Excision, benign skin lesion, face, ears, scalp; excised diameter over 4.0 cm.

CPT Code 11426 refers to the surgical excision of a benign skin lesion located on the face, ears, or scalp, where the excised diameter exceeds 4.0 cm. This procedure is typically performed to remove lesions that may be causing discomfort, cosmetic concerns, or have the potential for malignancy.

When CPT Code 11426 is Used?

This code is applicable in various clinical scenarios, including:

Large benign skin lesions that require surgical removal.
Lesions that are symptomatic, such as causing pain or irritation.
Cosmetic concerns where the lesion affects the appearance of the face, ears, or scalp.
Lesions that have changed in size, shape, or color, warranting further evaluation.

Symptoms Indicating This Procedure

Patients may report the following symptoms or clinical findings:

Visible growths or bumps on the skin that are larger than 4.0 cm.
Itching, tenderness, or pain associated with the lesion.
Changes in the appearance of the lesion, such as bleeding or crusting.
Concerns about the cosmetic appearance of the lesion.

Causes and Risk Factors

Several factors can contribute to the development of benign skin lesions, including:

Genetic predisposition to skin growths.
Sun exposure leading to skin changes.
Age-related skin changes.
Previous skin injuries or infections.

Diagnostic Tests Before Procedure

Before proceeding with the excision, the following diagnostic tests may be conducted:

Physical examination of the lesion.
Dermatoscopy to assess the characteristics of the lesion.
Biopsy if there is suspicion of malignancy.

Procedure Description

The excision procedure typically follows these steps:

Patient is positioned comfortably and the area is cleaned.
Local anesthesia is administered to numb the area.
A surgical incision is made around the lesion.
The lesion is carefully excised along with a margin of healthy tissue.
The wound is closed with sutures or adhesive strips.
Dressing is applied to protect the area.

Preparation for the Procedure

Patients should follow these preparation steps:

Consult with the healthcare provider about medications to avoid.
Arrive at the appointment with clean skin, free of lotions or makeup.
Discuss any allergies or medical conditions with the provider.
Arrange for transportation if sedation is used.

Recovery and Aftercare

Post-procedure recovery typically involves:

Resting for the remainder of the day after the procedure.
Keeping the surgical site clean and dry.
Changing dressings as instructed by the healthcare provider.
Taking prescribed pain medications as needed.

Possible Complications

While generally safe, potential complications include:

Infection at the surgical site.
Excessive bleeding or hematoma formation.
Scarring or changes in skin pigmentation.
Recurrence of the lesion.

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Post-Procedure Follow-Up

Follow-up care is essential for monitoring recovery:

Schedule a follow-up appointment within 1-2 weeks to assess healing.
Monitor for signs of infection or complications.
Discuss pathology results if a biopsy was performed.

Alternative Treatments

Non-surgical options may include:

Topical treatments for smaller lesions.
Cryotherapy to freeze off benign growths.
Laser therapy for cosmetic concerns.

Home Care Tips

Patients can follow these tips for effective home care:

Avoid picking at the surgical site.
Use gentle cleansers to wash the area.
Apply sunscreen to protect the healing skin.
Follow all aftercare instructions provided by the healthcare provider.

Patient Education & Prevention

To prevent recurrence and promote skin health:

Regularly check skin for new or changing lesions.
Use sunscreen to protect against UV damage.
Maintain a healthy lifestyle to support skin health.
Consult a dermatologist for regular skin checks.

Billing and Coding Information

CPT Code: 11426

Category: Surgical Procedures

Common Modifiers:

50 (bilateral procedure)
59 (distinct procedural service)

Average Cost and Insurance Coverage

The cost for this procedure can vary widely:

Average cost ranges from $500 to $2,000 depending on location and complexity.
Most insurance plans cover excision of benign lesions if deemed medically necessary.
Patients should verify coverage with their insurance provider.