D23.39 — Other benign neoplasm of skin of other parts of face
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Full policy text not provided; required documentation (medical records, prior authorization, forms) cannot be extracted from the supplied content.
- This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
- All documentation must be maintained in the patient's medical record, legible, include complete patient identification, dates of service, and the legible signature of the responsible practitioner, and be made available to the contractor upon request.
- The submitted medical record must support the use of the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must describe the service performed.
Key Coverage Criteria
- Full policy text not provided; specific clinical indications for blepharoplasty, eyelid surgery, and brow lift cannot be extracted from the supplied content.
- Services that meet the Medicare reasonable and necessary requirements per Local Coverage Determination (LCD) L35090 are covered when billed as reconstructive or medically necessary procedures.
- Dermabrasion for treatment of rhinophyma is covered when the medical record documents the beneficiary's rhinophyma disease process supporting medical necessity.
- Abdominal lipectomy/panniculectomy is covered when the pannus causes chronic intertrigo (skin irritation, infection, or chafing) and there is documented functional impairment (e.g., difficulty walking, exercising, or activities of daily living) after conservative treatment.
- Removal of breast implants as reconstructive breast surgery is covered when the medical record describes a condition that makes implant removal medically reasonable and necessary.
- Reduction mammaplasty is covered when the record documents height and weight, clinical signs/symptoms attributed to macromastia, prior therapies and responses, and contains operative and pathology reports with tissue weight removed from each breast and an age‑appropriate mammogram report.
20 Active Policies
A58774 — Billing and Coding: Cosmetic and Reconstructive Surgery
J05
L35498 — Removal of Benign Skin Lesions
J05
L39051 — Cosmetic and Reconstructive Surgery
J05
A57482 — Billing and Coding: Removal of Benign Skin Lesions
J05
L36850 — Peripheral Nerve Blocks
Related Codes
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