I78.1 — Nevus, non-neoplastic
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Claims submitted without a valid ICD-10-CM diagnosis code will be returned as incomplete; the diagnosis code must best describe the patient's condition for the service performed.
- The patient's medical record must contain documentation fully supporting medical necessity including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
- Medical record must document history and physical findings supporting a diagnosis of symptomatic varicose veins.
- Medical record must document failure of an adequate trial of conservative treatment as described in the LCD.
Key Coverage Criteria
- Interventional treatments are covered for symptomatic varicose veins of the lower extremity when the medical record documents history and physical findings supporting the diagnosis.
- Coverage requires failure of an adequate trial of conservative treatment prior to interventional therapy as described in the LCD.
- Coverage requires exclusion of other causes of limb edema, ulceration, and pain prior to treatment of varicose veins.
- Coverage requires performance of appropriate diagnostic testing (e.g., duplex ultrasound) to confirm the presence and location of incompetent perforating veins when indicated.
- Removal of benign or malignant skin lesions is addressed per the Local Coverage Determination L33445 and related billing/coding guidance.
- Diagnosis code L82.0 (inflamed seborrheic keratosis) may be used when the medical record documents the patient's complaint or the physician's physical findings for the lesion.
18 Active Policies
L35498 — Removal of Benign Skin Lesions
J05
A57482 — Billing and Coding: Removal of Benign Skin Lesions
J05
A52870 — Billing and Coding: Treatment of Varicose Veins of the Lower Extremity
J06
L33575 — Varicose Veins of the Lower Extremity, Treatment of
J06
Related Codes
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