D22.21 — Melanocytic nevi of right ear and external auricular canal
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Maintain all documentation in the patient’s medical record and make it available to the contractor upon request.
- Ensure every page of the record is legible and includes appropriate patient identification information, such as complete name and dates of service.
- Include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
- The submitted medical record must support the use of the selected ICD-10-CM code(s).
Key Coverage Criteria
- Report histopathologic examination separately when performed using CPT codes 88304-88305.
- Select the CPT code for lesion removal by measuring the greatest clinical diameter of the apparent lesion plus the margin required for complete excision, with measurement made prior to excision.
- When shave removal is performed solely to obtain a pathologic diagnosis, report tangential (shave) biopsy CPT codes 11102-11103 instead of shave removal codes.
- Follow the reasonable and necessary requirements in LCD L34938 for coverage determinations of benign skin lesion removal.
- CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
- Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
20 Active Policies
A59261 — Billing and Coding: MolDX: Molecular Assays for the Diagnosis of Cutaneous Melanoma
J05
L39479 — MolDX: Molecular Assays for the Diagnosis of Cutaneous Melanoma
J05
A57482 — Billing and Coding: Removal of Benign Skin Lesions
J05
L35498 — Removal of Benign Skin Lesions
J05
Related Codes
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