H61.001 — Unspecified perichondritis of right external ear
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.
- 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.
6 Active Policies
A57113 — Billing and Coding: Removal of Benign Skin Lesions
J12
L34938 — Removal of Benign Skin Lesions
J12
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)
L34233 — Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)
Related Codes
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