L73.8 — Other specified follicular disorders
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Claims must include an ICD-10-CM diagnosis code that represents the reason for the procedure, billed to the highest level of specificity and linked to the appropriate procedure code.
- Medical records must support that a surgical debridement was performed when billing surgical debridement CPT codes (11000-11012, 11042-11047).
- Documentation substantiating depth of debridement is encouraged when billing CPT 11044 and may be required to support the level of surgical debridement billed.
- Medical records must document the symptomatic nature of a hyperkeratotic lesion for CPT 11055-11057 to be coverable.
Key Coverage Criteria
- CPT 97597, 97598, and 97602 are appropriate for medically necessary selective or non-selective debridement of skin ulcers, circumscribed dermal infections, conditions affecting contiguous deeper structures, and removal of ground-in dirt (e.g., road abrasions) when supported by the medical record.
- Surgical debridement CPT codes 11000-11012 and 11042-11047 are appropriate to report when surgical removal of devitalized tissue is performed and the CPT code selected reflects the deepest tissue type actually removed.
- Paring codes CPT 11055-11057 may be used for paring/cutting of symptomatic hyperkeratosis when the medical record documents the lesion is symptomatic and thus medically necessary.
- Low-frequency, non-contact, non-thermal ultrasound (MIST therapy) CPT 97610 is allowable for treatment of a qualifying wound (one 97610 service per day).
- When the only service performed is non-surgical cleansing of the ulcer site with or without application of a surgical dressing, bill an appropriate Evaluation and Management (E/M) code rather than a debridement code.
- Wound care is covered for wounds and ulcers refractory to healing or with complicated healing cycles due to the wound's nature or complicating metabolic/physiologic factors.
4 Active Policies
AETNA-CPB-0300 — Hair Analysis
AETNA-CPB-0633 — Benign Skin Lesion Removal
A58565 — Billing and Coding: Wound and Ulcer Care
L38902 — Wound and Ulcer Care
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.