If you’ve ever stared at a list of CPT dermatology codes and felt your eyes glaze over, you’re not alone. Dermatology coding sits at a tricky intersection. You have medical issues like skin cancer. You have surgical procedures like excisions. And you have cosmetic or destructive treatments like cryotherapy.
Getting the codes right matters—not just for reimbursement, but for patient records and avoiding audits.
This guide walks you through the most common dermatology CPT codes in plain English. No confusing jargon. No unrealistic promises. Just honest, practical help.
We’ll look at biopsy codes, excision codes, destruction codes, and even repair codes. By the end, you’ll feel more confident picking the right code for the right situation.
Why Dermatology Coding Is Unique
Dermatology is one of the few specialties where you regularly perform a procedure and send the tissue to pathology without admitting a patient to a hospital. Most dermatology procedures happen in an office setting.
That means you’re dealing with two separate coding systems at once:
- CPT codes for what you did (biopsy, excision, destruction).
- Pathology codes for what the lab found.
And here’s where it gets tricky. A single lesion can be coded in multiple ways depending on:
- Depth (is it partial or full thickness?)
- Method (scalpel, punch, shave, or laser?)
- Reason (suspicious mole, benign cosmetic bump, or cancerous growth?)
The same lesion could be billed with three different codes based on how you remove it. That’s why understanding the nuance matters.
Note: Payers are cracking down on unbundling. You cannot bill for a biopsy and then a separate excision of the same lesion during the same visit without proper documentation of medical necessity.
How to Read a CPT Code in Dermatology
Every CPT code has five digits. No letters. No decimals. In dermatology, codes often fall into ranges:
| Code Range | Procedure Category |
|---|---|
| 11100–11107 | Biopsy |
| 11300–11313 | Shave removal |
| 11400–11646 | Excision (benign vs malignant) |
| 12000–13160 | Wound repair (simple, intermediate, complex) |
| 17000–17286 | Destruction (cryo, laser, electrosurgery) |
| 17311–17315 | MOHs surgery |
One golden rule: Measure the lesion before removal. Measure the final defect after removal for excisions. For shaves, the excised diameter matters. For excisions, the excised diameter (including margins) matters.
Let’s break down each family.
Biopsy Codes (11100–11107)
Biopsies are the workhorses of dermatology. You take a small piece of skin for diagnosis. Historically, coders used 11100 for one biopsy and 11101 for each additional. That changed.
As of recent years, the code set now includes:
- 11102 – Tangential biopsy (shave biopsy) of a single lesion
- 11103 – Each separate/additional tangential biopsy
- 11104 – Punch biopsy (single lesion)
- 11105 – Each separate/additional punch biopsy
- 11106 – Incisional biopsy (single lesion)
- 11107 – Each separate/additional incisional biopsy
When to use each one
- Tangential (11102/11103) – A shave biopsy that removes a portion of skin rising above the surface. Think superficial lesions.
- Punch (11104/11105) – A circular blade removes a full-thickness core of skin, including dermis and sometimes subcutaneous fat.
- Incisional (11106/11107) – A scalpel removes a narrow slice (like a wedge) from a larger mass. Often used for large or deep lesions.
Real-world example
A patient has three suspicious moles. You perform:
- One tangential biopsy on a raised seborrheic keratosis.
- Two punch biopsies on two different pigmented lesions.
You bill: 11102 (first tangential) + 11105 x 2 (additional punches, each separately). Payers generally allow multiple biopsy codes for different lesions.
Critical note: Do not bill multiple biopsies from the exact same lesion. One biopsy per lesion. Two biopsies from the same suspicious area get bundled.
Common mistake
Using excision codes when you performed a deep punch biopsy. A punch biopsy is still a biopsy. Even if it removes the entire lesion. If pathology calls it “diagnostic” and you didn’t plan for definitive treatment, stick with biopsy codes.
Excision Codes (11400–11646)
Excision means full-thickness removal of a lesion down to the subcutaneous fat (or deeper), followed by closure. This is not a shave. Not a biopsy. You are cutting out the entire lesion with margins.
Excision codes split into two main categories:
- Benign lesions (11400–11471)
- Malignant lesions (11600–11646)
Benign excision codes (11400–11406)
These are based on excised diameter (the lesion plus the narrowest margin).
| Code | Excised Diameter (cm) |
|---|---|
| 11400 | 0.6 to 1.0 |
| 11401 | 1.1 to 2.0 |
| 11402 | 2.1 to 3.0 |
| 11403 | 3.1 to 4.0 |
| 11404 | 4.1 to 5.0 |
| 11406 | over 5.0 |
Measure carefully: You document the lesion size before excision. Then you document the excised diameter. The code is based on the excised diameter, not the lesion size.
Example: A 0.8 cm benign nevus. You excise with 0.2 cm margins. Total excised diameter = 1.2 cm. You bill 11401.
Malignant excision codes (11600–11646)
Exactly the same measurement logic, but for basal cell carcinoma, squamous cell carcinoma, melanoma, etc.
| Code | Excised Diameter (cm) |
|---|---|
| 11600 | 0.6 to 1.0 |
| 11601 | 1.1 to 2.0 |
| 11602 | 2.1 to 3.0 |
| 11603 | 3.1 to 4.0 |
| 11604 | 4.1 to 5.0 |
| 11606 | over 5.0 |
Does closure get billed separately?
Generally, no. Simple layer closure (one layer of stitches) is included in the excision code. If you perform an intermediate (deep layer) or complex (layered, Z-plasty, etc.) closure, you can bill a repair code separately. But you must check payer rules.
Reminder: If you plan to send the tissue for pathology, you cannot bill both an excision and a separate biopsy of the same lesion during the same encounter.
Destruction Codes (17110–17286)
Destruction means you remove or obliterate a lesion without taking tissue for pathology. Common methods: cryotherapy (liquid nitrogen), electrosurgery, laser ablation, or chemical destruction.
Benign lesions (17110–17111)
- 17110 – Destruction of up to 14 benign lesions (excluding genital and plantar warts)
- 17111 – Destruction of 15 or more benign lesions
Think seborrheic keratoses, skin tags, or milia.
Malignant and premalignant (17260–17286)
These codes are for actinic keratoses (AKs), superficial BCCs, or squamous cell carcinoma in situ when destruction is chosen over excision.
| Code | Lesion type |
|---|---|
| 17260 | Malignant, face/neck/hands/feet/genitalia |
| 17261 | Malignant, trunk/arms/legs |
| 17262 | Malignant, scalp/neck/hands/feet (larger) |
| 17266 | Actinic keratosis, first lesion |
| 17267 | Actinic keratosis, 2–14 lesions |
| 17268 | Actinic keratosis, 15+ lesions |
Important distinction: 17266–17268 are specifically for AKs treated with cryotherapy or topical agents like liquid nitrogen. If you treat AKs with photodynamic therapy (PDT), those are different codes (96567, 96573).
Common scenario
A patient has 10 AKs on the bald scalp. You apply liquid nitrogen to each.
You bill: 17267 for 2–14 lesions. Do not bill per lesion.
Shave Removal Codes (11300–11313)
Shave removal sits between a biopsy and an excision. You remove a lesion at the level of the dermis using a blade. No sutures are typically needed, though you may use light cautery.
These codes are based on size of the lesion (not excised diameter).
| Code | Lesion diameter (cm) |
|---|---|
| 11300 | 0.5 or less |
| 11301 | 0.6 to 1.0 |
| 11302 | 1.1 to 2.0 |
| 11303 | 2.1 to 3.0 |
| 11305 | over 3.0 (scalp, neck, hands, feet, genitalia) |
| 11306 | over 3.0 (trunk, arms, legs) |
| 11310 | Face, 0.5 or less |
| 11311 | Face, 0.6 to 1.0 |
| 11312 | Face, 1.1 to 2.0 |
| 11313 | Face, 2.1 to 3.0 |
Shave vs biopsy
If you shave a lesion and send it to pathology for diagnosis, you could technically use a tangential biopsy code (11102). But if you intend to remove the lesion entirely (even without diagnosis), you use shave codes.
Clarity from payers: Many commercial insurers prefer shave codes for definitive removal and biopsy codes for diagnostic sampling. Check your local policies.
Repair and Closure Codes (12000–13160)
When you perform an excision or a trauma repair, you may need to close the wound. Repair codes depend on:
- Complexity (simple, intermediate, complex)
- Location (face vs trunk vs extremities)
- Length in centimeters
Simple repair (12001–12021)
One-layer closure. Superficial. Typically uses adhesive strips, surgical tape, or superficial sutures.
| Code | Location | Length (cm) |
|---|---|---|
| 12001 | Scalp/neck/trunk/extremities | 2.5 or less |
| 12002 | Same | 2.6 to 7.5 |
| 12004 | Same | 7.6 to 12.5 |
| 12005 | Same | 12.6 to 20.0 |
| 12011 | Face/ears/eyelids/nose/lips | 2.5 or less |
| 12013 | Same | 2.6 to 5.0 |
| 12014 | Same | 5.1 to 7.5 |
Intermediate repair (12031–12057)
Includes deeper layer closure (subcutaneous tissue) plus superficial closure.
Complex repair (13100–13160)
Requires layered closure, debridement, or scar revision techniques.
When not to bill separately
If your excision report says “closed with simple sutures,” do not add a repair code. It’s bundled. Only add repair when the closure is more extensive than typical for that excision.
MOHs Micrographic Surgery Codes (17311–17315)
MOHs is a specialized technique for skin cancer. The surgeon acts as both surgeon and pathologist, examining 100% of the margins.
- 17311 – MOHs, first stage, up to 5 tissue blocks
- 17312 – Each additional stage after the first (same lesion)
- 17313 – MOHs, first stage, 6–10 blocks
- 17314 – Each additional stage, 6–10 blocks
- 17315 – Each additional block beyond 10 (per block)
These codes include the surgery, pathology interpretation, and repair (if any). Do not bill separate excision or repair codes with MOHs.
Important: MOHs is only for certain tumors (recurrent BCC, large SCC, ill-defined margins). Not every skin cancer qualifies.
Common Denials and How to Avoid Them
Even experienced coders face denials. Here are the top dermatology coding denials and simple fixes.
Denial 1: Unbundling biopsy and excision
Problem: You bill a biopsy code and an excision code for the same lesion on the same day.
Fix: Decide before the procedure. If you’re going for diagnosis only, use biopsy. If you’re doing definitive removal, use excision. Only bill both if the biopsy was done at a separate patient encounter (different date).
Denial 2: Wrong size measurement
Problem: You code based on lesion size instead of excised diameter.
Fix: Document both. “Lesion size 0.6 cm. Excised with 0.3 cm margins. Total excised diameter 1.2 cm.” Then code off 1.2 cm.
Denial 3: Missing modifiers for multiple lesions
Problem: You bill 11401 x 3 for three separate lesions on the same day.
Fix: Use modifier 59 (or XS, XU) to show distinct procedural services. Most payers require modifiers for multiple excisions.
Denial 4: Billing destruction and biopsy together
Problem: You cryo an AK and biopsy a different lesion. Payer bundles them.
Fix: Use modifier 59 on the destruction code. Add a note in the medical record that they are separate sites, unrelated.
Documentation Tips That Save Time
Good documentation is your best defense against denials and audits. Here’s a quick checklist.
For every lesion:
- Location (e.g., “left upper back, 3 cm lateral to T4”)
- Pre-procedure size (greatest diameter)
- Type of procedure (punch, shave, excision, cryo)
- Margins (for excision)
- Excised diameter (for excision)
- Closure method (if any)
- Specimen handling (if sent to pathology)
Pro tip: Use a templated procedure note. Your EMR can auto-fill much of this. Train your staff to never leave “size” blank.
Note: For shave removals and biopsies, you don’t need margins. For excisions, margins are required.
Conclusion
CPT dermatology codes don’t have to be intimidating. Once you understand the key differences—biopsy vs excision, destruction vs shave, benign vs malignant—the numbers start to make sense. Always measure carefully. Document completely. And when in doubt, check the specific payer policy for your area. Master these basics, and you’ll save your practice time, money, and audit stress.
FAQ
1. Can I bill a biopsy and an excision on the same lesion on the same day?
No. Payers consider this unbundling. Choose one based on your intent. If you biopsy first and then decide to excise, the excision is usually not separately payable.
2. What’s the difference between 17110 and 17266?
17110 is for benign lesions (skin tags, seborrheic keratoses). 17266 is for actinic keratoses (premalignant). Do not mix them.
3. How do I code for a patient with 20 skin tags removed?
Use 17110 for up to 14 lesions. For 20 lesions, you still use 17110 (up to 14) – many payers do not have a code for 15+ benign except 17111 (which excludes genital and plantar warts only, not skin tags). Check local policy.
4. Do I need a modifier for two excisions on the same arm?
Yes. Use modifier 59 or XS (separate structure) to show they are distinct lesions not on a continuous incision.
5. Can I bill a repair code after a shave removal?
Generally, no. Shave removals include light cautery or simple closure by definition. If you perform layered closure, you likely performed an excision, not a shave.
6. What if I excise a lesion and the pathology comes back benign?
You still code the excision based on what you thought at the time. If you documented “suspicious for malignancy,” use malignant codes. If you documented “benign nevus,” use benign codes. Do not change the code based on pathology results unless the intent changed.
Additional Resource
For the most up-to-date official guidance, refer to the American Academy of Dermatology (AAD) Coding and Documentation Toolkit. You can find it directly on their website under Practice Management Tools.
🔗 Suggested link: AAD Coding Resources (Always verify current year updates, as CPT codes change periodically.)
Disclaimer: This article is for educational purposes only. CPT codes are copyright of the American Medical Association. Coding rules vary by payer, region, and date of service. Always verify with your specific payer policies and consult a certified medical coder for complex cases. The author does not guarantee reimbursement outcomes.
