D23.70 — Other benign neoplasm of skin of unspecified lower limb, including hip
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Clinical records must clearly document medical necessity and an explicit rationale for why removal is not cosmetic when billing CPT 17106-17108.
- Coding and billing guidance must be used with the associated Local Coverage Determination; coverage details for CPT 11055-11057 are delineated in the Medicare Internet-Only Manual and should be followed for claims.
- Maintain all documentation in the patient's medical record and make it available to the contractor upon request; every page must be legible and include patient identifiers (complete name, dates of service).
- Medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
Key Coverage Criteria
- Removal of benign skin lesions billed with CPT 17106, 17107, or 17108 is covered only when clinical records document medical necessity and explicitly state why the procedure is not cosmetic.
- Treatment of hyperkeratotic lesions (e.g., corns and calluses) billed with CPT 11055, 11056, or 11057 is covered as described in the Medicare Internet-Only Manual.
- Peripheral nerve blocks are covered when they meet the reasonable and necessary requirements specified in LCD L33933.
- Peripheral nerve block is reasonable when the patient's pain appears due to a classic mononeuritis but neuro-diagnostic studies fail to provide a structural explanation.
- Peripheral nerve blocks are reasonable for peripheral nerve injuries/entrapment or extremity trauma that lead to complex regional pain syndrome (CRPS).
- Selective peripheral nerve blockade is reasonable diagnostically when the clinical picture is unclear to isolate the specific pain source.
6 Active Policies
A57162 — Billing and Coding: Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)
A57161 — Billing and Coding: Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)
A57788 — Billing and Coding: Peripheral Nerve Blocks
L34233 — Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)
L33933 — Peripheral Nerve Blocks
Related Codes
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