R23.8 — Other skin changes
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.
- Allergy testing for inhalant allergens is covered when medically necessary; evaluation may include up to 90 prick-puncture tests followed by up to 40 intracutaneous tests if prick/puncture results are negative.
- Allergy testing for food sensitivity is covered when medically necessary and may require up to 40 percutaneous tests.
5 Active Policies
A57113 — Billing and Coding: Removal of Benign Skin Lesions
J12
L34938 — Removal of Benign Skin Lesions
J12
AETNA-CPB-0577 — Laser Treatment for Psoriasis and Other Selected Skin Conditions
A57181 — Billing and Coding: Allergy Testing
L34313 — Allergy Testing
Related Codes
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