L56.5 — Disseminated superficial actinic porokeratosis (DSAP)
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Legible medical records must reference the patient's complaint or the physician's physical findings when billing with diagnosis L82.0.
- Documentation must support a significant, separately identifiable E/M service when modifier 25 is appended (separate E/M note tied to the visit and not just the procedure).
- Verify applicable procedure and global policy coding via the Medicare Physician Fee Schedule Database (MPFSDB) to determine where the global surgical policy applies.
- Maintain all documentation in the patient’s medical record and make it available to the contractor upon request.
Key Coverage Criteria
- 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.
- 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.
11 Active Policies
L35498 — Removal of Benign Skin Lesions
J05
A57482 — Billing and Coding: Removal of Benign Skin Lesions
J05
L34938 — Removal of Benign Skin Lesions
J12
A57113 — Billing and Coding: Removal of Benign Skin Lesions
J12
L34233 — Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)
Related Codes
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