L98.2 — Febrile neutrophilic dermatosis [Sweet]
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This policy provides billing, coding, and guideline information that complements the Local Coverage Determination (LCD) 'Cosmetic and Reconstructive Surgery' L33428; the full policy content is not included here, so specific documentation requirements (e.g., medical records, prior authorizations, forms) are not available in the provided excerpt.
- Documentation supporting the claim must be maintained in the medical record and be available to Medicare upon request.
- Each claim must be submitted with ICD-10-CM code(s) that reflect the patient's condition and reasons for the service; claims without ICD-10-CM codes will be returned.
- For diagnostic tests related to the service, report the test result if known; if the result is not known, report the signs or symptoms that prompted the test.
Key Coverage Criteria
- Follow the related Local Coverage Determination (LCD) for clinical indications and medical necessity criteria for reduction mammaplasty.
- Excision of a benign skin lesion is covered when there is clinical suspicion of malignancy (e.g., ICD-10-CM D48.5) documented in the medical record.
- Removal is covered to address disturbance of skin sensation when documented (ICD-10-CM R20.0-R20.3, R20.8).
- Removal is covered when documented objective changes (e.g., increase in size) support a diagnosis warranting excision.
- Removal of a benign lesion is covered when the treating physician documents medical necessity for removal (physician judgment that lesion merits 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.
15 Active Policies
L35001 — Reduction Mammaplasty
J06
A56837 — Billing and Coding: Reduction Mammaplasty
J06
A56658 — Billing and Coding: Cosmetic and Reconstructive Surgery
A57044 — Billing and Coding: Removal of Benign Skin Lesions
A57161 — Billing and Coding: Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)
Related Codes
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