Z86.006 — Personal history of melanoma in-situ
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.
- This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
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.
- CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
- Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
- G71.21 | Nemaline myopathy
- G83.0 | Diplegia of upper limbs
8 Active Policies
A57215 — Billing and Coding: MRI and CT Scans of the Head and Neck
A56346 — Billing and Coding: Removal of Benign and Malignant Skin Lesions
A56612 — Billing and Coding: CT of the Head
A57204 — Billing and Coding: MRI and CT Scans of the Head and Neck
L34417 — CT of the Head
Related Codes
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