LCD Reference Article Billing and Coding Article

Billing and Coding: Removal of Benign and Malignant Skin Lesions

A56346

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Contractor Information

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General Information

Source Article ID
N/A
Article ID
A56346
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Removal of Benign and Malignant Skin Lesions
Article Type
Billing and Coding
Original Effective Date
01/01/2019
Revision Effective Date
10/01/2024
Revision Ending Date
N/A
Retirement Date
N/A

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Removal of Benign and Malignant Skin Lesions L33445.

When using diagnosis code L82.0 (inflamed seborrheic keratosis), the legible medical records should reference a patient’s complaint or a physician’s physical findings.

Check the Medicare Physician Fee Schedule Database (MPFSDB) for the codes where the global policy would be applied. Use modifier 25 appended to the appropriate visit code to indicate that the patient's condition required a significant, separately identifiable service by the same physician on the same day of the procedure that was performed.

Response To Comments

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Coding Information

Bill Type Codes

Code Description

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Revenue Codes

Code Description

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

Group 1

(1 Code)
Group 1 Paragraph

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Group 1 Codes
Code Description
25 SIGNIFICANT, SEPARATELY IDENTIFIABLE EVALUATION AND MANAGEMENT SERVICE BY THE SAME PHYSICIAN ON THE SAME DAY OF THE PROCEDURE OR OTHER SERVICE: THE PHYSICIAN MAY NEED TO INDICATE THAT ON THE DAY A PROCEDURE OR SERVICE IDENTIFIED BY A CPTCODE WAS PERFORMED, THE PATIENT'S CONDITION REQUIRED A SIGNIFICANT, SEPARATELY IDENTIFIABLE E/M SERVICE ABOVE AND BEYOND THE OTHER SERVICE PROVIDED OR BEYOND THE USUAL PREOPERATIVE AND POSTOPERATIVE CARE ASSOCIATED WITH THE PROCEDURE THAT WAS PERFORMED. THE E/M SERVICE MAY BE PROMPTED BY THE SYMPTOM OR CONDITION FOR WHICH THE PROCEDURE AND/OR SERVICE WAS PROVIDED. AS SUCH, DIFFERENT DIAGNOSES ARE NOT REQUIRED FOR REPORTING OF THE E/M SERVICES ON THE SAME DATE. THIS CIRCUMSTANCE MAY BE REPORTED BY ADDING THE MODIFIER -25 TO THE APPROPRIATE LEVEL OF E/M SERVICE, OR THE SEPARATE FIVE DIGIT MODIFIER 09925 MAY BE USED. NOTE: THIS MODIFIER IS NOT USED TO REPORT AN E/M SERVICE THAT RESULTED IN A DECISION TO PERFORM SURGERY. SEE MODIFIER -57.
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ICD-10-CM Codes that Support Medical Necessity

Group 1

(249 Codes)
Group 1 Paragraph

The CPT/HCPCS codes included in this LCD will be subjected to "procedure to diagnosis" editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary.

Group 1 Codes
Code Description
A63.0 Anogenital (venereal) warts
B07.0 Plantar wart
B07.8 Other viral warts
B07.9 Viral wart, unspecified
B08.1 Molluscum contagiosum
C43.0 Malignant melanoma of lip
C43.111 Malignant melanoma of right upper eyelid, including canthus
C43.112 Malignant melanoma of right lower eyelid, including canthus
C43.121 Malignant melanoma of left upper eyelid, including canthus
C43.122 Malignant melanoma of left lower eyelid, including canthus
C43.21 Malignant melanoma of right ear and external auricular canal
C43.22 Malignant melanoma of left ear and external auricular canal
C43.30 Malignant melanoma of unspecified part of face
C43.31 Malignant melanoma of nose
C43.39 Malignant melanoma of other parts of face
C43.4 Malignant melanoma of scalp and neck
C43.51 Malignant melanoma of anal skin
C43.52 Malignant melanoma of skin of breast
C43.59 Malignant melanoma of other part of trunk
C43.61 Malignant melanoma of right upper limb, including shoulder
C43.62 Malignant melanoma of left upper limb, including shoulder
C43.71 Malignant melanoma of right lower limb, including hip
C43.72 Malignant melanoma of left lower limb, including hip
C43.8 Malignant melanoma of overlapping sites of skin
C4A.0 Merkel cell carcinoma of lip
C4A.111 Merkel cell carcinoma of right upper eyelid, including canthus
C4A.112 Merkel cell carcinoma of right lower eyelid, including canthus
C4A.121 Merkel cell carcinoma of left upper eyelid, including canthus
C4A.122 Merkel cell carcinoma of left lower eyelid, including canthus
C4A.21 Merkel cell carcinoma of right ear and external auricular canal
C4A.22 Merkel cell carcinoma of left ear and external auricular canal
C4A.31 Merkel cell carcinoma of nose
C4A.39 Merkel cell carcinoma of other parts of face
C4A.4 Merkel cell carcinoma of scalp and neck
C4A.52 Merkel cell carcinoma of skin of breast
C4A.59 Merkel cell carcinoma of other part of trunk
C4A.61 Merkel cell carcinoma of right upper limb, including shoulder
C4A.62 Merkel cell carcinoma of left upper limb, including shoulder
C4A.71 Merkel cell carcinoma of right lower limb, including hip
C4A.72 Merkel cell carcinoma of left lower limb, including hip
C44.00 Unspecified malignant neoplasm of skin of lip
C44.01 Basal cell carcinoma of skin of lip
C44.02 Squamous cell carcinoma of skin of lip
C44.09 Other specified malignant neoplasm of skin of lip
C44.1021 Unspecified malignant neoplasm of skin of right upper eyelid, including canthus
C44.1022 Unspecified malignant neoplasm of skin of right lower eyelid, including canthus
C44.1091 Unspecified malignant neoplasm of skin of left upper eyelid, including canthus
C44.1092 Unspecified malignant neoplasm of skin of left lower eyelid, including canthus
C44.1121 Basal cell carcinoma of skin of right upper eyelid, including canthus
C44.1122 Basal cell carcinoma of skin of right lower eyelid, including canthus
C44.1191 Basal cell carcinoma of skin of left upper eyelid, including canthus
C44.1192 Basal cell carcinoma of skin of left lower eyelid, including canthus
C44.1221 Squamous cell carcinoma of skin of right upper eyelid, including canthus
C44.1222 Squamous cell carcinoma of skin of right lower eyelid, including canthus
C44.1291 Squamous cell carcinoma of skin of left upper eyelid, including canthus
C44.1292 Squamous cell carcinoma of skin of left lower eyelid, including canthus
C44.131 Sebaceous cell carcinoma of skin of unspecified eyelid, including canthus
C44.1321 Sebaceous cell carcinoma of skin of right upper eyelid, including canthus
C44.1322 Sebaceous cell carcinoma of skin of right lower eyelid, including canthus
C44.1391 Sebaceous cell carcinoma of skin of left upper eyelid, including canthus
C44.1392 Sebaceous cell carcinoma of skin of left lower eyelid, including canthus
C44.1921 Other specified malignant neoplasm of skin of right upper eyelid, including canthus
C44.1922 Other specified malignant neoplasm of skin of right lower eyelid, including canthus
C44.1991 Other specified malignant neoplasm of skin of left upper eyelid, including canthus
C44.1992 Other specified malignant neoplasm of skin of left lower eyelid, including canthus
C44.202 Unspecified malignant neoplasm of skin of right ear and external auricular canal
C44.209 Unspecified malignant neoplasm of skin of left ear and external auricular canal
C44.212 Basal cell carcinoma of skin of right ear and external auricular canal
C44.219 Basal cell carcinoma of skin of left ear and external auricular canal
C44.222 Squamous cell carcinoma of skin of right ear and external auricular canal
C44.229 Squamous cell carcinoma of skin of left ear and external auricular canal
C44.292 Other specified malignant neoplasm of skin of right ear and external auricular canal
C44.299 Other specified malignant neoplasm of skin of left ear and external auricular canal
C44.301 Unspecified malignant neoplasm of skin of nose
C44.309 Unspecified malignant neoplasm of skin of other parts of face
C44.311 Basal cell carcinoma of skin of nose
C44.319 Basal cell carcinoma of skin of other parts of face
C44.321 Squamous cell carcinoma of skin of nose
C44.329 Squamous cell carcinoma of skin of other parts of face
C44.391 Other specified malignant neoplasm of skin of nose
C44.399 Other specified malignant neoplasm of skin of other parts of face
C44.40 Unspecified malignant neoplasm of skin of scalp and neck
C44.41 Basal cell carcinoma of skin of scalp and neck
C44.42 Squamous cell carcinoma of skin of scalp and neck
C44.49 Other specified malignant neoplasm of skin of scalp and neck
C44.500 Unspecified malignant neoplasm of anal skin
C44.501 Unspecified malignant neoplasm of skin of breast
C44.509 Unspecified malignant neoplasm of skin of other part of trunk
C44.510 Basal cell carcinoma of anal skin
C44.511 Basal cell carcinoma of skin of breast
C44.519 Basal cell carcinoma of skin of other part of trunk
C44.520 Squamous cell carcinoma of anal skin
C44.521 Squamous cell carcinoma of skin of breast
C44.529 Squamous cell carcinoma of skin of other part of trunk
C44.590 Other specified malignant neoplasm of anal skin
C44.591 Other specified malignant neoplasm of skin of breast
C44.599 Other specified malignant neoplasm of skin of other part of trunk
C44.602 Unspecified malignant neoplasm of skin of right upper limb, including shoulder
C44.609 Unspecified malignant neoplasm of skin of left upper limb, including shoulder
C44.612 Basal cell carcinoma of skin of right upper limb, including shoulder
C44.619 Basal cell carcinoma of skin of left upper limb, including shoulder
C44.622 Squamous cell carcinoma of skin of right upper limb, including shoulder
C44.629 Squamous cell carcinoma of skin of left upper limb, including shoulder
C44.692 Other specified malignant neoplasm of skin of right upper limb, including shoulder
C44.699 Other specified malignant neoplasm of skin of left upper limb, including shoulder
C44.702 Unspecified malignant neoplasm of skin of right lower limb, including hip
C44.709 Unspecified malignant neoplasm of skin of left lower limb, including hip
C44.712 Basal cell carcinoma of skin of right lower limb, including hip
C44.719 Basal cell carcinoma of skin of left lower limb, including hip
C44.722 Squamous cell carcinoma of skin of right lower limb, including hip
C44.729 Squamous cell carcinoma of skin of left lower limb, including hip
C44.792 Other specified malignant neoplasm of skin of right lower limb, including hip
C44.799 Other specified malignant neoplasm of skin of left lower limb, including hip
C44.80 Unspecified malignant neoplasm of overlapping sites of skin
C44.81 Basal cell carcinoma of overlapping sites of skin
C44.82 Squamous cell carcinoma of overlapping sites of skin
C44.89 Other specified malignant neoplasm of overlapping sites of skin
C46.0 Kaposi's sarcoma of skin
C47.0 Malignant neoplasm of peripheral nerves of head, face and neck
C49.0 Malignant neoplasm of connective and soft tissue of head, face and neck
C49.11 Malignant neoplasm of connective and soft tissue of right upper limb, including shoulder
C49.12 Malignant neoplasm of connective and soft tissue of left upper limb, including shoulder
C49.21 Malignant neoplasm of connective and soft tissue of right lower limb, including hip
C49.22 Malignant neoplasm of connective and soft tissue of left lower limb, including hip
C49.4 Malignant neoplasm of connective and soft tissue of abdomen
C49.5 Malignant neoplasm of connective and soft tissue of pelvis
C49.6 Malignant neoplasm of connective and soft tissue of trunk, unspecified
C51.0 Malignant neoplasm of labium majus
C51.1 Malignant neoplasm of labium minus
C51.2 Malignant neoplasm of clitoris
C51.8 Malignant neoplasm of overlapping sites of vulva
C51.9 Malignant neoplasm of vulva, unspecified
C60.0 Malignant neoplasm of prepuce
C60.1 Malignant neoplasm of glans penis
C60.2 Malignant neoplasm of body of penis
C60.8 Malignant neoplasm of overlapping sites of penis
C60.9 Malignant neoplasm of penis, unspecified
C63.2 Malignant neoplasm of scrotum
C79.2 Secondary malignant neoplasm of skin
C86.60 Primary cutaneous CD30-positive T-cell proliferations not having achieved remission
C88.80 Other malignant immunoproliferative diseases not having achieved remission
C96.29 Other malignant mast cell neoplasm
D03.0 Melanoma in situ of lip
D03.111 Melanoma in situ of right upper eyelid, including canthus
D03.112 Melanoma in situ of right lower eyelid, including canthus
D03.121 Melanoma in situ of left upper eyelid, including canthus
D03.122 Melanoma in situ of left lower eyelid, including canthus
D03.21 Melanoma in situ of right ear and external auricular canal
D03.22 Melanoma in situ of left ear and external auricular canal
D03.39 Melanoma in situ of other parts of face
D03.4 Melanoma in situ of scalp and neck
D03.51 Melanoma in situ of anal skin
D03.52 Melanoma in situ of breast (skin) (soft tissue)
D03.59 Melanoma in situ of other part of trunk
D03.61 Melanoma in situ of right upper limb, including shoulder
D03.62 Melanoma in situ of left upper limb, including shoulder
D03.71 Melanoma in situ of right lower limb, including hip
D03.72 Melanoma in situ of left lower limb, including hip
D03.8 Melanoma in situ of other sites
D04.0 Carcinoma in situ of skin of lip
D04.111 Carcinoma in situ of skin of right upper eyelid, including canthus
D04.112 Carcinoma in situ of skin of right lower eyelid, including canthus
D04.121 Carcinoma in situ of skin of left upper eyelid, including canthus
D04.122 Carcinoma in situ of skin of left lower eyelid, including canthus
D04.21 Carcinoma in situ of skin of right ear and external auricular canal
D04.22 Carcinoma in situ of skin of left ear and external auricular canal
D04.30 Carcinoma in situ of skin of unspecified part of face
D04.39 Carcinoma in situ of skin of other parts of face
D04.4 Carcinoma in situ of skin of scalp and neck
D04.5 Carcinoma in situ of skin of trunk
D04.61 Carcinoma in situ of skin of right upper limb, including shoulder
D04.62 Carcinoma in situ of skin of left upper limb, including shoulder
D04.71 Carcinoma in situ of skin of right lower limb, including hip
D04.72 Carcinoma in situ of skin of left lower limb, including hip
D07.1 Carcinoma in situ of vulva
D07.4 Carcinoma in situ of penis
D10.0 Benign neoplasm of lip
D21.0 Benign neoplasm of connective and other soft tissue of head, face and neck
D21.11 Benign neoplasm of connective and other soft tissue of right upper limb, including shoulder
D21.12 Benign neoplasm of connective and other soft tissue of left upper limb, including shoulder
D21.21 Benign neoplasm of connective and other soft tissue of right lower limb, including hip
D21.22 Benign neoplasm of connective and other soft tissue of left lower limb, including hip
D21.3 Benign neoplasm of connective and other soft tissue of thorax
D21.4 Benign neoplasm of connective and other soft tissue of abdomen
D21.5 Benign neoplasm of connective and other soft tissue of pelvis
D21.6 Benign neoplasm of connective and other soft tissue of trunk, unspecified
D21.9 Benign neoplasm of connective and other soft tissue, unspecified
D22.0 Melanocytic nevi of lip
D22.111 Melanocytic nevi of right upper eyelid, including canthus
D22.112 Melanocytic nevi of right lower eyelid, including canthus
D22.121 Melanocytic nevi of left upper eyelid, including canthus
D22.122 Melanocytic nevi of left lower eyelid, including canthus
D22.21 Melanocytic nevi of right ear and external auricular canal
D22.22 Melanocytic nevi of left ear and external auricular canal
D22.30 Melanocytic nevi of unspecified part of face
D22.39 Melanocytic nevi of other parts of face
D22.4 Melanocytic nevi of scalp and neck
D22.5 Melanocytic nevi of trunk
D22.61 Melanocytic nevi of right upper limb, including shoulder
D22.62 Melanocytic nevi of left upper limb, including shoulder
D22.71 Melanocytic nevi of right lower limb, including hip
D22.72 Melanocytic nevi of left lower limb, including hip
D23.0 Other benign neoplasm of skin of lip
D23.111 Other benign neoplasm of skin of right upper eyelid, including canthus
D23.112 Other benign neoplasm of skin of right lower eyelid, including canthus
D23.121 Other benign neoplasm of skin of left upper eyelid, including canthus
D23.122 Other benign neoplasm of skin of left lower eyelid, including canthus
D23.21 Other benign neoplasm of skin of right ear and external auricular canal
D23.22 Other benign neoplasm of skin of left ear and external auricular canal
D23.30 Other benign neoplasm of skin of unspecified part of face
D23.39 Other benign neoplasm of skin of other parts of face
D23.4 Other benign neoplasm of skin of scalp and neck
D23.5 Other benign neoplasm of skin of trunk
D23.61 Other benign neoplasm of skin of right upper limb, including shoulder
D23.62 Other benign neoplasm of skin of left upper limb, including shoulder
D23.71 Other benign neoplasm of skin of right lower limb, including hip
D23.72 Other benign neoplasm of skin of left lower limb, including hip
D28.0 Benign neoplasm of vulva
D29.0 Benign neoplasm of penis
D29.4 Benign neoplasm of scrotum
D47.01 Cutaneous mastocytosis
D48.5 Neoplasm of uncertain behavior of skin
I78.1 Nevus, non-neoplastic
L56.5 Disseminated superficial actinic porokeratosis (DSAP)
L57.0 Actinic keratosis
L57.8 Other skin changes due to chronic exposure to nonionizing radiation
L72.0 Epidermal cyst
L72.11 Pilar cyst
L72.2 Steatocystoma multiplex
L72.3 Sebaceous cyst
L72.8 Other follicular cysts of the skin and subcutaneous tissue
L72.9 Follicular cyst of the skin and subcutaneous tissue, unspecified
L82.0 Inflamed seborrheic keratosis
L83 Acanthosis nigricans
L90.0 Lichen sclerosus et atrophicus
L92.8 Other granulomatous disorders of the skin and subcutaneous tissue
L94.0 Localized scleroderma [morphea]
L94.1 Linear scleroderma
L94.3 Sclerodactyly
L98.0 Pyogenic granuloma
N84.3 Polyp of vulva
N90.0 Mild vulvar dysplasia
N90.1 Moderate vulvar dysplasia
N90.4 Leukoplakia of vulva
N90.7 Vulvar cyst
Z85.820 Personal history of malignant melanoma of skin
Z85.828 Personal history of other malignant neoplasm of skin
Z86.006 Personal history of melanoma in-situ
Z86.007 Personal history of in-situ neoplasm of skin
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

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Group 1 Codes

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ICD-10-PCS Codes

Group 1

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Group 1 Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/01/2024 R14

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes added C86.60 and C88.80. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/24.

05/01/2024 R13

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes added C46.0.

01/01/2024 R12

Under CPT/HCPCS Codes Group 1: Codes the description was revised for 17260, 17261, 17262, 17263, 17264, 17266, 17270, 17271, 17272, 17273, 17274, 17276, 17280, 17281, 17282, 17283, 17284 and 17286. This revision is due to the 2024 Annual/Q1 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/24.

Punctuation and formatting errors were corrected throughout the article. This revision is effective 1/1/24.

05/12/2022 R11

Under ICD-10-CM Codes that Support Medical Necessity - Group 1: Codes added codes C49.11, C49.12, C49.21, C49.22, C49.4, C49.5, C49.6, and C79.2.

This revision has a retroactive effective date of 1/1/22.

04/15/2022 R10

Under ICD-10-CM Codes that Support Medical Necessity - Group 1: Codes added code N84.3.

12/01/2021 R9

Under ICD-10-CM Codes that Support Medical Necessity - Group 1: Codes added codes N90.0. N90.1 and N90.4.

09/23/2021 R8

Under ICD-10-CM Codes that Support Medical Necessity - Group 1: Codes added code N90.7.

12/20/2020 R7

Under ICD-10 Codes that Support Medical Necessity - Group 1: Codes added codes D07.1 and D07.4.

10/05/2020 R6

Under ICD-10 Codes that Support Medical Necessity - Group 1: Codes added code D10.0.

10/17/2019 R5

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Title XVIII of the Social Security Act, §1833(e) was removed from the CMS National Coverage Policy section of the related Removal of Benign and Malignant Skin Lesions L33445 LCD and placed in this article. Under Article Text deleted the subheadings Documentation Requirements and Utilization Guidelines. Under CPT/HCPCS Modifiers added modifier 25.

10/01/2019 R4

Under Covered ICD-10 Codes Group 1: Codes added ICD-10 Codes Z86.006 and Z86.007. This revision is due to the Annual ICD-10 Code Update and becomes effective on 10/1/2019.

08/23/2019 R3

The Article Title was changed to “Billing and Coding: Removal of Benign and Malignant Skin Lesions”. Under Covered ICD-10 Codes Group 1: Codes added ICD-10 code L72.11.

03/21/2019 R2

All verbiage regarding medical necessity under the Article Text section has been removed and is included in the related Removal of Benign and Malignant Skin Lesions L33445 LCD.

01/01/2019 R1

Under CPT/HCPCS Codes Group 1: Codes removed codes 11102, 11103, 11104, 11105, 11106 and 11107 being that the Removal of Benign and Malignant Skin Lesions LCD does not discuss biopsies.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L33445 - Removal of Benign and Malignant Skin Lesions
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Public Versions
Updated On Effective Dates Status
08/14/2024 10/01/2024 - N/A Currently in Effect You are here
03/19/2024 05/01/2024 - 09/30/2024 Superseded View
12/28/2023 01/01/2024 - 04/30/2024 Superseded View
05/02/2022 05/12/2022 - 12/31/2023 Superseded View
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Keywords

  • Skin Lesions
  • Actinic Keratosis
  • Lesions