L85.3 — Xerosis cutis
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.
- Genetic testing for Lynch syndrome is covered when the patient meets the reasonable and necessary clinical criteria specified in LCD L34912.
- MMR (mismatch repair) germline mutation testing is covered when appropriate tumor screening with immunohistochemistry (IHC) or microsatellite instability (MSI) testing indicates need for germline testing.
4 Active Policies
A57450 — Billing and Coding: Genetic Testing for Lynch Syndrome
J09
L34912 — Genetic Testing for Lynch Syndrome
J09
A57113 — Billing and Coding: Removal of Benign Skin Lesions
J12
L34938 — Removal of Benign Skin Lesions
J12
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.