LCD for Removal of Benign Skin Lesions (L27362)


Contractor Information

 
Contractor Name 
National Government Services, Inc.
Contractor Number
NumberTypeState(s)
00130 FI IN
00131 FI IL
00160 FI KY
00332 FI OH
00450 FI WI
00452 FI MI
00453 FI VA, WV
00630 Carrier IN
00660 Carrier KY
13101 MAC CT – Part A
13102 MAC CT – Part B
13201 MAC NY – Part A
13202 MAC NY – Part B
13282 MAC NY – Part B
13292 MAC NY – Part B
Contractor Type 
Carrier
Fiscal Intermediary
MAC – Part A
MAC- Part B


LCD Information

 
LCD ID Number 
L27362 
 
LCD Title 
Removal of Benign Skin Lesions 
 
Contractor's Determination Number 
L27362 (R8) 
 
AMA CPT / ADA CDT Copyright Statement 
CPT codes, descriptions and other data only are copyright 2010 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.  
 
CMS National Coverage Policy 
Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:

Title XVIII of the Social Security Act (SSA):

Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
 
 
Primary Geographic Jurisdiction
NumberTypeState(s)
00130 FI IN
00131 FI IL
00160 FI KY
00332 FI OH
00450 FI WI
00452 FI MI
00453 FI VA, WV
00630 Carrier IN
00660 Carrier KY
13101 MAC CT – Part A
13102 MAC CT – Part B
13201 MAC NY – Part A
13202 MAC NY – Part B
13282 MAC NY – Part B
13292 MAC NY – Part B
 
Oversight Region
Region I, II, III, V
 
 
Original Determination Effective Date 
For services performed on or after 11/15/2008  
 
Original Determination Ending Date 
 
 
Revision Effective Date 
For services performed on or after 02/01/2011  
 
Revision Ending Date 
 
 
Indications and Limitations of Coverage and/or Medical Necessity 
Abstract:

Benign skin lesions are common in the elderly and are frequently removed at the patient's request to improve appearance. Removals of certain benign skin lesions that do not pose a threat to health or function are considered cosmetic, and as such, are not covered by the Medicare program. These cosmetic reasons include, but are not limited to, emotional distress, "makeup trapping," and non-problematic lesions in any anatomic location. Lesions in sensitive anatomical locations that are not creating problems do not qualify for removal coverage on the basis of location alone.

Benign skin lesions to which the accompanying lesion removal policy applies are the following: seborrheic keratoses, sebaceous (epidermoid) cysts, skin tags, moles (nevi), acquired hyperkeratosis (keratoderma), molluscum contagiosum, milia and viral warts.

Medicare covers the destruction of actinic keratoses without restrictions based on lesion or patient characteristics.

Indications:

There may be instances in which the removal of benign seborrheic keratoses, sebaceous cysts, skin tags, moles (nevi), acquired hyperkeratosis (keratoderma), molluscum contagiosum, milia and viral warts is medically appropriate. Medicare will, therefore, consider their removal as medically necessary, and not cosmetic, if one or more of the following conditions are presented and clearly documented in the medical record:

  • Bleeding;
  • Intense itching;
  • Pain;
  • Change in physical appearance (reddening or pigmentary change);
  • Recent enlargement;
  • Increase in the number of lesions;
  • Physical evidence of inflammation or infection, e.g., purulence, oozing, edema, erythema, etc.;
  • Lesion obstructs an orifice;
  • Lesion clinically restricts eye function. For example:
    1. Lesion restricts eyelid function;
    2. lesion causes misdirection of eyelashes or eyelid;
    3. lesion restricts lacrimal puncta and interferes with tear flow;
    4. lesion touches globe;
  • Clinical uncertainty as to the likely diagnosis, particularly where malignancy is a realistic consideration based on lesion appearance;
  • A prior biopsy suggests or is indicative of lesion malignancy;
  • The lesion is in an anatomical region subject to recurrent physical trauma, and there is documentation that such trauma has, in fact, occurred;
  • Recent enlargement, history of rupture or previous inflammation, or location subjects patient to risk of rupture of epidermal inclusion (sebaceous) cyst.
  • Wart removals will be covered under the guidelines above. In addition, wart destruction will be covered when any of the following clinical circumstances are present:
    1. Periocular warts associated with chronic recurrent conjunctivitis thought secondary to lesion virus shedding;
    2. Warts showing evidence of spread from one body area to another, particularly in immunosuppressed patients or warts of recent origin in an immunocompromised patients;
    3. Lesions are condyloma acuminata or molluscum contagiosum;
    4. Cervical dysplasia or pregnancy is associated with genital warts.
    Limitations:

    Medicare will not pay for a separate E & M service on the same day as a minor surgical procedure unless a documented significant and separately identifiable medical service is rendered. The service must be fully and clearly documented in the patient’s medical record and a modifier 25 should be used.

    Medicare will not pay for a separate E & M service by the operating physician during the global period unless the service is for a medical problem unrelated to the surgical procedure. The service must be fully and clearly documented in the patient’s medical record.

    If the beneficiary wishes one or more of these benign asymptomatic lesions removed for cosmetic purposes, the beneficiary becomes liable for the service rendered. The physician has the responsibility to notify the patient in advance that Medicare will not cover cosmetic dermatological surgery and that the beneficiary will be liable for the cost of the service. It is strongly advised that the beneficiary, by his or her signature, accept responsibility for payment. Charges should be clearly stated as well.

    The type of removal is at the discretion of the treating physician and the appropriateness of the technique used will not be a factor in deciding if a lesion merits removal. However, a benign lesion excision (CPT 11400-11446) must have medical record documentation as to why an excisional removal, other than for cosmetic purposes, was the surgical procedure of choice. Excision is defined as full-thickness (through the dermis) removal of a lesion, including margins, and includes simple (non-layered) closure when performed. Each benign lesion excised should be reported separately. Code selection is determined by measuring the greatest clinical diameter of the apparent lesion plus that margin required for complete excision (lesion diameter plus the most narrow margins required equals the excised diameter). The margins refer to the most narrow margin required to adequately excise the lesion, based on the physician's judgment. The measurement of lesion plus margin is made prior to excision.

    Other Comments:

    For claims submitted to the fiscal intermediary or Part A MAC: this coverage determination also applies within states outside the primary geographic jurisdiction with facilities that have nominated National Government Services to process their claims.

    Bill type codes only apply to providers who bill these services to the fiscal intermediary or Part A MAC. Bill type codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

    Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item or procedure may not be covered by Medicare. The limitation of liability and refund requirements do not apply when the test, item or procedure is statutorily excluded, has no Medicare benefit category or is rendered for screening purposes.

    For dates of service prior to April 1, 2010, FQHC services should be reported with bill type 73X. For dates of service on or after April 1, 2010, bill type 77X should be used to report FQHC services. 
     


    Coding Information

     
    Bill Type Codes: 

    Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

    011x Hospital Inpatient (Including Medicare Part A)
    012x Hospital Inpatient (Medicare Part B only)
    013x Hospital Outpatient
    071x Clinic - Rural Health
    073x Clinic - Freestanding
    077x Clinic - Federally Qualified Health Center (FQHC)
    085x Critical Access Hospital
     
     
    Revenue Codes: 

    Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

    Revenue codes only apply to providers who bill these services to the fiscal intermediary or Part A MAC. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

    Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.

    All revenue codes billed on the inpatient claim for the dates of service in question may be subject to review.

    0360 Operating Room Services - General Classification
    0361 Operating Room Services - Minor Surgery
    0369 Operating Room Services - Other OR Services
    0456 Emergency Room - Urgent Care
    0490 Ambulatory Surgical Care - General Classification
    0499 Ambulatory Surgical Care - Other Ambulatory Surgical
    0510 Clinic - General Classification
    0516 Clinic - Urgent Care Clinic
    0520 Free-Standing Clinic - General Classification
    0761 Specialty Services - Treatment Room
    0960 Professional Fees - General Classification
    0969 Professional Fees - Other Professional Fee
    0975 Professional Fees - Operating Room
    0982 Professional Fees - Outpatient Services
    0983 Professional Fees - Clinic
     
     
    CPT/HCPCS Codes 

    11200 REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS
    11201 REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; EACH ADDITIONAL 10 LESIONS, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
    11300 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER 0.5 CM OR LESS
    11301 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER 0.6 TO 1.0 CM
    11302 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER 1.1 TO 2.0 CM
    11303 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER OVER 2.0 CM
    11305 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 0.5 CM OR LESS
    11306 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 0.6 TO 1.0 CM
    11307 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 1.1 TO 2.0 CM
    11308 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER OVER 2.0 CM
    11310 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 0.5 CM OR LESS
    11311 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 0.6 TO 1.0 CM
    11312 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 1.1 TO 2.0 CM
    11313 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER OVER 2.0 CM
    11400 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 0.5 CM OR LESS
    11401 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 0.6 TO 1.0 CM
    11402 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 1.1 TO 2.0 CM
    11403 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 2.1 TO 3.0 CM
    11404 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 3.1 TO 4.0 CM
    11406 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER OVER 4.0 CM
    11420 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.5 CM OR LESS
    11421 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.6 TO 1.0 CM
    11422 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 1.1 TO 2.0 CM
    11423 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 2.1 TO 3.0 CM
    11424 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 3.1 TO 4.0 CM
    11426 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER OVER 4.0 CM
    11440 EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 0.5 CM OR LESS
    11441 EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 0.6 TO 1.0 CM
    11442 EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 1.1 TO 2.0 CM
    11443 EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 2.1 TO 3.0 CM
    11444 EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 3.1 TO 4.0 CM
    11446 EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER OVER 4.0 CM
    17000 DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), PREMALIGNANT LESIONS (EG, ACTINIC KERATOSES); FIRST LESION
    17003 DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), PREMALIGNANT LESIONS (EG, ACTINIC KERATOSES); SECOND THROUGH 14 LESIONS, EACH (LIST SEPARATELY IN ADDITION TO CODE FOR FIRST LESION)
    17004 DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), PREMALIGNANT LESIONS (EG, ACTINIC KERATOSES), 15 OR MORE LESIONS
    17106 DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); LESS THAN 10 SQ CM
    17107 DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); 10.0 TO 50.0 SQ CM
    17108 DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); OVER 50.0 SQ CM
    17110 DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), OF BENIGN LESIONS OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; UP TO 14 LESIONS
    17111 DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), OF BENIGN LESIONS OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; 15 OR MORE LESIONS
    17340 CRYOTHERAPY (CO2 SLUSH, LIQUID N2) FOR ACNE
     
     
    ICD-9 Codes that Support Medical Necessity 
    It is the responsibility of the provider to code to the highest level specified in the ICD-9-CM (e.g., to the fourth or fifth digit). The correct use of an ICD-9-CM code does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination.

    The ICD-9-CM codes listed below identify the lesion being treated and will, by themselves, be considered for payment:

    078.0 MOLLUSCUM CONTAGIOSUM
    078.11 CONDYLOMA ACUMINATUM
    235.1 NEOPLASM OF UNCERTAIN BEHAVIOR OF LIP ORAL CAVITY AND PHARYNX
    236.3 NEOPLASM OF UNCERTAIN BEHAVIOR OF OTHER AND UNSPECIFIED FEMALE GENITAL ORGANS
    236.6 NEOPLASM OF UNCERTAIN BEHAVIOR OF OTHER AND UNSPECIFIED MALE GENITAL ORGANS
    238.2 NEOPLASM OF UNCERTAIN BEHAVIOR OF SKIN
    239.2 NEOPLASM OF UNSPECIFIED NATURE OF BONE SOFT TISSUE AND SKIN
    374.84 CYSTS OF EYELIDS
    686.1 PYOGENIC GRANULOMA OF SKIN AND SUBCUTANEOUS TISSUE
    702.0 ACTINIC KERATOSIS
    702.11 INFLAMED SEBORRHEIC KERATOSIS
    For the conditions below, a Primary ICD-9-CM code AND a Secondary ICD-9-CM code that represents a complication are required:

    Primary Diagnoses:


    078.10 VIRAL WARTS UNSPECIFIED
    078.12 PLANTAR WART
    078.19 OTHER SPECIFIED VIRAL WARTS
    210.0 BENIGN NEOPLASM OF LIP
    210.4 BENIGN NEOPLASM OF OTHER AND UNSPECIFIED PARTS OF MOUTH
    214.0 LIPOMA OF SKIN AND SUBCUTANEOUS TISSUE OF FACE
    214.1 LIPOMA OF OTHER SKIN AND SUBCUTANEOUS TISSUE
    216.0 BENIGN NEOPLASM OF SKIN OF LIP
    216.1 BENIGN NEOPLASM OF EYELID INCLUDING CANTHUS
    216.2 BENIGN NEOPLASM OF EAR AND EXTERNAL AUDITORY CANAL
    216.3 BENIGN NEOPLASM OF SKIN OF OTHER AND UNSPECIFIED PARTS OF FACE
    216.4 BENIGN NEOPLASM OF SCALP AND SKIN OF NECK
    216.5 BENIGN NEOPLASM OF SKIN OF TRUNK EXCEPT SCROTUM
    216.6 BENIGN NEOPLASM OF SKIN OF UPPER LIMB INCLUDING SHOULDER
    216.7 BENIGN NEOPLASM OF SKIN OF LOWER LIMB INCLUDING HIP
    216.8 BENIGN NEOPLASM OF OTHER SPECIFIED SITES OF SKIN
    216.9 BENIGN NEOPLASM OF SKIN SITE UNSPECIFIED
    221.1 BENIGN NEOPLASM OF VAGINA
    221.2 BENIGN NEOPLASM OF VULVA
    222.1 BENIGN NEOPLASM OF PENIS
    222.4 BENIGN NEOPLASM OF SCROTUM
    228.01 HEMANGIOMA OF SKIN AND SUBCUTANEOUS TISSUE
    237.71 NEUROFIBROMATOSIS TYPE 1 VON RECKLINGHAUSEN'S DISEASE
    237.73 SCHWANNOMATOSIS
    237.79 OTHER NEUROFIBROMATOSIS
    274.81 GOUTY TOPHI OF EAR
    274.82 GOUTY TOPHI OF OTHER SITES EXCEPT EAR
    373.2 CHALAZION
    374.51 XANTHELASMA OF EYELID
    455.9 RESIDUAL HEMORRHOIDAL SKIN TAGS
    528.4 CYSTS OF ORAL SOFT TISSUES
    528.6 LEUKOPLAKIA OF ORAL MUCOSA INCLUDING TONGUE
    528.8 ORAL SUBMUCOSAL FIBROSIS INCLUDING OF TONGUE
    616.2 CYST OF BARTHOLIN'S GLAND
    624.01 VULVAR INTRAEPITHELIAL NEOPLASIA I [VIN I]
    624.02 VULVAR INTRAEPITHELIA LNEOPLASIA II [VIN II]
    624.6 POLYP OF LABIA AND VULVA
    701.1 KERATODERMA ACQUIRED
    701.4 KELOID SCAR
    701.5 OTHER ABNORMAL GRANULATION TISSUE
    701.8 OTHER SPECIFIED HYPERTROPHIC AND ATROPHIC CONDITIONS OF SKIN
    701.9 UNSPECIFIED HYPERTROPHIC AND ATROPHIC CONDITIONS OF SKIN
    702.19 OTHER SEBORRHEIC KERATOSIS
    702.8 OTHER SPECIFIED DERMATOSES
    706.2 SEBACEOUS CYST
    709.2 SCAR CONDITIONS AND FIBROSIS OF SKIN
    709.3 DEGENERATIVE SKIN DISORDERS
    709.4 FOREIGN BODY GRANULOMA OF SKIN AND SUBCUTANEOUS TISSUE
    709.9 UNSPECIFIED DISORDER OF SKIN AND SUBCUTANEOUS TISSUE
    727.40 SYNOVIAL CYST UNSPECIFIED
    744.1 ACCESSORY AURICLE
    744.47 PREAURICULAR CYST
    757.32 VASCULAR HAMARTOMAS
    757.33 CONGENITAL PIGMENTARY ANOMALIES OF SKIN
    757.39 OTHER SPECIFIED CONGENITAL ANOMALIES OF SKIN
    782.2 LOCALIZED SUPERFICIAL SWELLING MASS OR LUMP
    Secondary Diagnoses:

    279.00 HYPOGAMMAGLOBULINEMIA UNSPECIFIED
    279.01 SELECTIVE IGA IMMUNODEFICIENCY
    279.02 SELECTIVE IGM IMMUNODEFICIENCY
    279.03 OTHER SELECTIVE IMMUNOGLOBULIN DEFICIENCIES
    279.04 CONGENITAL HYPOGAMMAGLOBULINEMIA
    279.05 IMMUNODEFICIENCY WITH INCREASED IGM
    279.06 COMMON VARIABLE IMMUNODEFICIENCY
    279.09 OTHER DEFICIENCY OF HUMORAL IMMUNITY
    279.10 IMMUNODEFICIENCY WITH PREDOMINANT T-CELL DEFECT UNSPECIFIED
    279.11 DIGEORGE'S SYNDROME
    279.12 WISKOTT-ALDRICH SYNDROME
    279.13 NEZELOF'S SYNDROME
    279.19 OTHER DEFICIENCY OF CELL-MEDIATED IMMUNITY
    279.2 COMBINED IMMUNITY DEFICIENCY
    279.3 UNSPECIFIED IMMUNITY DEFICIENCY
    279.41 AUTOIMMUNE LYMPHOPROLIFERATIVE SYNDROME
    279.49 AUTOIMMUNE DISEASE, NOT ELSEWHERE CLASSIFIED
    338.19 OTHER ACUTE PAIN
    368.40 VISUAL FIELD DEFECT UNSPECIFIED
    368.44 OTHER LOCALIZED VISUAL FIELD DEFECT
    368.8 OTHER SPECIFIED VISUAL DISTURBANCES
    368.9 UNSPECIFIED VISUAL DISTURBANCE
    369.8 UNQUALIFIED VISUAL LOSS ONE EYE
    372.10 CHRONIC CONJUNCTIVITIS UNSPECIFIED
    372.11 SIMPLE CHRONIC CONJUNCTIVITIS
    372.12 CHRONIC FOLLICULAR CONJUNCTIVITIS
    372.30 CONJUNCTIVITIS UNSPECIFIED
    374.81 HEMORRHAGE OF EYELID
    459.0 HEMORRHAGE UNSPECIFIED
    682.0 CELLULITIS AND ABSCESS OF FACE
    682.1 CELLULITIS AND ABSCESS OF NECK
    682.2 CELLULITIS AND ABSCESS OF TRUNK
    682.3 CELLULITIS AND ABSCESS OF UPPER ARM AND FOREARM
    682.4 CELLULITIS AND ABSCESS OF HAND EXCEPT FINGERS AND THUMB
    682.5 CELLULITIS AND ABSCESS OF BUTTOCK
    682.6 CELLULITIS AND ABSCESS OF LEG EXCEPT FOOT
    682.7 CELLULITIS AND ABSCESS OF FOOT EXCEPT TOES
    682.8 CELLULITIS AND ABSCESS OF OTHER SPECIFIED SITES
    682.9 CELLULITIS AND ABSCESS OF UNSPECIFIED SITES
    686.8 OTHER SPECIFIED LOCAL INFECTIONS OF SKIN AND SUBCUTANEOUS TISSUE
    686.9 UNSPECIFIED LOCAL INFECTION OF SKIN AND SUBCUTANEOUS TISSUE
    692.9 CONTACT DERMATITIS AND OTHER ECZEMA UNSPECIFIED CAUSE
    695.89 OTHER SPECIFIED ERYTHEMATOUS CONDITIONS
    695.9 UNSPECIFIED ERYTHEMATOUS CONDITION
    698.9 UNSPECIFIED PRURITIC DISORDER
    708.9 UNSPECIFIED URTICARIA
    729.5 PAIN IN LIMB
    782.0 DISTURBANCE OF SKIN SENSATION
    959.8 OTHER AND UNSPECIFIED INJURY TO OTHER SPECIFIED SITES INCLUDING MULTIPLE
    V10.82 PERSONAL HISTORY OF MALIGNANT MELANOMA OF SKIN
    V10.83 PERSONAL HISTORY OF OTHER MALIGNANT NEOPLASM OF SKIN
    V58.77 AFTERCARE FOLLOWING SURGERY OF THE SKIN AND SUBCUTANEOUS TISSUE NOT ELSEWHERE CLASSIFIED
     
     
    Diagnoses that Support Medical Necessity 
    Not applicable 
     
    ICD-9 Codes that DO NOT Support Medical Necessity 
    Not applicable
     
     
    ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation 
     
     
    Diagnoses that DO NOT Support Medical Necessity 
    Not applicable 


    General Information

     
    Documentation Requirements 
    The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

    Each claim must be submitted with ICD-9-CM codes that reflect the condition of the patient, and indicate the reason(s) for which the service was performed. Claims submitted without ICD-9-CM codes will be returned.

    Medical records maintained by the physician must clearly document the medical necessity for the lesion removal(s) if Medicare is billed for the service.

    A statement of "irritated skin lesion" will be insufficient justification for lesion removal when used solely to refer a patient, describe a complaint or the physician's physical findings. Similarly, use of an ICD-9 code 702.11 (Inflamed seborrheic keratosis) will be insufficient to justify lesion removal, without the medical record documentation of the patients' symptoms and physical findings. It is important to document the patient's signs and symptoms as well as the physician's physical findings.

    Drawings or diagrams to describe the precise anatomical location of the lesion are helpful. A procedural note, protocol describing indications, diagnosis, methodology of treatment, or modality is advised.

    The decision to submit a specimen for pathologic interpretation will be independent of the decision to remove or not remove the lesion. It is assumed, however, that a tissue diagnosis will be part of the medical record when an ultimately benign lesion is removed based on physician uncertainty as to the final clinical diagnosis.

    Not all of the conditions listed in the Indications section of this LCD represent a specific diagnosis, but may be conditions supporting a diagnosis. For example, if a lesion is excised because of suspicion of malignancy (e.g., ICD-9-CM code 238.2), the Medical Record might include “increase in size” to support this diagnosis. “Increase in size” might also support the diagnosis of disturbance of skin sensation (782.0).

    Documentation must be available to Medicare upon request. 
     
    Appendices 
    Not applicable 
     
    Utilization Guidelines 
    Clinically, it would not be expected that any given lesion would have to be treated more than once in a six months interval. The intrinsic nature of the lesion will determine whether more frequent treatments are required.

    This utilization guideline applies to all conditions within this LCD other than actinic keratosis. 
     
    Sources of Information and Basis for Decision 
    This bibliography presents those sources that were obtained during the development of this policy. National Government Services is not responsible for the continuing viability of Web site addresses listed below.

    1. American Academy of Dermatology© 1987m Revised 1991, 1993, 1999. Produced by NetOn-Line Services. Guidelines of Care for Actinic Keratoses (1995), Nevi 1 (1992) and Warts (1995). Seborrheic Keratoses, patient information.

    2. Caforio AL, Fortina AB, Piaserico S, et al. Skin Cancer in heart transplant recipients: risk factor analysis and relevance of immunosuppressive therapy. Circulation. 2000;102(19Suppl 3):III222-7.

    3. Cosmetic and Reconstructive Procedures in Plastic Surgery published by the American Society of Plastic and Reconstructive Surgeons, Inc. 1989.

    4. Epstein E. The Merck Manual of Diagnosis and Therapy, Section 10- Dermatologic disorders, Chapter 115, Viral skin infections topics, Ch 125, Benign tumors topics.

    5. Euvrard S, Lanitakis J, Decullier E, et al. Subsequent skin cancers in kidney and heart transplant receipients after the first squamous cell carcinoma. Tranplantation. 2006;81(8):1093-100.

    6. Ferris F. Clinical Advisor, Instant Diagnosis and Treatment. Mosby, Inc., an affiliate of Elsevier Inc. 2006.

    7. Guttman C. Routine destruction of AKs called unnecessary. Dermatology Times. 2000;21(4):36.

    8. HARRISON'S ONLINE Part 2.Cardinal Manifestations and Presentation of Diseases, Section 9. Available at http://www.merckmedicus.com/pp/us/hcp/hcp_home.jsp?tcode=H17TV&WT.mc_id=H17TV&WT.srch=1.

    9. Harrison’s Practice; Kasper, Braunwald, Fauci, Hauser, Longo, Jameson (eds). Alterations in the skin, Chapter 47. Eczema, psoriasis, cutaneous infections, acne, and other common skin disorders.

    10. Ho V, McLean D. General in Dermatology tumors epithelial. 4th Ed., McGraw Hill, Inc.:855-872.

    11. Karagas MR, Stukel TA, Greenberg ER, Baron JA, Mott LA, Stern RS. Risk of subsequent basal cell carcinoma and squamous cell carcinoma of the skin among patients with prior skin cancer. Skin Cancer Prevention Study Group. JAMA. 1992;267(24):3305-3310.

    12. Krusinski PA, Flowers FP. Common viral infections of the skin. Best Practice of Medicine. 1999;2:317-325.

    13. Marcil I, Stern RS. Risk of developing a subsequent nonmelanoma skin cancer in patients with a history of nonmelanoma skin cancer: a critical review of the literature and meta-analysis. Arch Dermatol. 2000;136(12):1524-1530.

    14. Other Carriers' medical policies:
      Nationwide Mutual Ins., West Virginia -policy # 2000-08LR
      Administar Federal, Inc., In. - policy INTEG-C-0801
      Trailblazer, Maryland – policy on Removal of Benign Skin Lesions
      Noridian Administrative Services, LLC - Non-malignant Skin Lesion Removal Policy.

    15. Stone MS, Lynch PJ. Viral warts in Principles and Practices of Dermatology, Churchhill Livingstone. 1990:119-127.

    16. The MERCK MANUAL of MEDICAL INFORMATION, Second Home Edition Online:1415.

    17. White GM, Cox NH. Diseases of the Skin, Section I Diseases and Disorders.

      Additional Sources added in support of Revision 3:

    18. Asadullah, K, Renz, H, Docke, W, et al. Verrucosis of hands and feet in a patient with combined immune deficiency. Journal of the American Academy of Dermatology. 1997;36(5):850-852. www.mdconsult.com/das/article.htm . Accessed 02/04/2009.

    19. Gui U, Soylu S, Yavuzer R. Epidermodysplasis verruciformis associated with isolated IgM deficiency. Indian Journal of Dermatology, Venereology and Leprology. 2007;73(6):420-422. www.ijdvl.com/printarticle.asp. Accessed 02/04/2009.

    20. Noble: Nonulcerative genital lesions. In: Textbook of Primary Care Medicine, 3rd ed. www.mdconsult.com/das/book.htm. Accessed 02/04/2009.

     
     
    Advisory Committee Meeting Notes 
    Carrier Advisory Committee Meeting Date(s):

    Indiana: 05/19/2008
    Kentucky: 05/22/2008
    New York: 04/30/2008

    This coverage determination does not reflect the sole opinion of the contractor or contractor Medical Director. Although the final decision rests with the contractor, this determination is developed in consultation with representatives from Advisory Committee members and/or from various state and local provider organizations. 
     
    Start Date of Comment Period 
    04/17/2008 
     
    End Date of Comment Period 
    05/31/2008 
     
    Start Date of Notice Period 
    02/01/2011 
     
    Revision History Number 
    R8 
     
    Revision History Explanation 
    R8 (effective 02/01/2011): LCD revised to add ICD-9 code 338.19 to the list of secondary diagnoses representing a complication supporting the need for removal of a lesion. No comment and notice periods required and none given.

    R7 (effective 10/01/2010): LCD revised for annual ICD-9-CM code updates for 2011. The “ICD-9-CM Codes That Support Medical Necessity” section of the policy is expanded as follows: ICD-9-CM codes 237.73 and 237.79 have been added to the primary diagnosis list effective for dates of service on or after 10/01/2010. No comment and notice periods required and none given.

    R6 (effective 04/01/2010): LCD revised to clarify documentation required for excisions performed on lesions that have increased in size. Bill type information for FQHC services revised to add bill type 77x. Minor formatting changes made. No comment and notice periods required and none given.

    R5 (effective 10/01/2009): LCD revised to add ICD-9-CM code 701.1 to list of primary diagnosis codes requiring a secondary diagnosis under the ICD-9 Codes that Support Medical Necessity section. This addition is effective for services performed on or after November 15, 2008, the original effective date of the LCD; ICD-9 codes 279.41 and 279.49 added to replace deleted code 279.4 for 2010 ICD-9 Update; Limitations section revised to refer to replace “dermatologic services: with “minor surgical procedures” performed on the same day as E&M services; effective date for adding ICD-9 code 078.12 in R4 corrected to November 15, 2008; minor formatting changes made; No comment and notice periods required and none given.

    R4 (effective 07/01/2009) Source of revision – internal/external. LCD revised to add ICD-9-CM code 709.9 to list of primary diagnosis codes requiring a secondary diagnosis, payable under ICD-9 Codes that Support Medical Necessity section, for reporting lesions of unknown behavior; ICD-9-CM code 078.12 was added to list of primary diagnoses requiring a secondary diagnosis, effective for services performed on or after November 15, 2008; Documentation Requirements section revised to delete instruction for coding neoplasms of uncertain morphology; minor formatting changes made; no comment and notice periods required and none given. (Revision history updated to reflect a correction in the ICD-9 coding lists with no change in effective date.)

    05/15/2009 - In accordance with Section 911 of the Medicare Modernization Act of 2003, fiscal intermediary numbers 00180 and 00181 were removed from this LCD as the claims processing for Maine and Massachusetts was transitioned to NHIC, the Part A/Part B MAC contractor in these states.

    06/05/2009 - In accordance with Section 911 of the Medicare Modernization Act of 2003, fiscal intermediary number 00270 was removed from this LCD as the claims processing for New Hampshire and Vermont was transitioned to NHIC, the Part A/Part B MAC contractor in these states.

    R3 (effective 03/01/2009): Source of revision – external. LCD corrected to include ICD-9-CM codes 279.10, 279.11, 279.12, 279.13, 279.19, 279.2, 279.3, and 279.4 to the list of secondary diagnosis codes under ICD-9 Codes that Support Medical Necessity, as these codes were inadvertently omitted from the original LCD; additional sources listed. The correction is effective 11/15/2008, when the LCD was finalized. No comment and notice periods required and none given.

    R2 (effective 02/01/2009): Source of revision – external. ICD-9-CM code V58.77 added to list of secondary diagnoses, and has an effective date of 11/15/2008, as this was omitted in error from original LCD; Documentation Requirements section revised to list ICD-9-CM code 239.2, instead of 238.2, for neoplasms of uncertain nature. No comment and notice periods required and none given.

    R1(effective 01/01/2009): Source of revision – Internal (annual HCPCS update for 2009). CPT code 11201 has been revised to include the phrase, "or part thereof". No comment and notice periods required and none given.

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    The following are administrative notes entered by Medicare Coverage Database Contractor:

    07/18/2008 - In accordance with Section 911 of the Medicare Modernization Act of 2003, Carrier Contractor Number 00803 was removed from this LCD as the claims processing for downstate New York was transitioned to MAC Part B Contractor Number 13202.

    08/08/2009 - This policy was updated by the ICD-9 2009-2010 Annual Update.

    8/10/2009 - The description for Revenue code 0761 was changed

    3/7/2010 - The description for Bill Type Code 73 was changed

    8/1/2010 - The description for Bill Type Code 11 was changed
    8/1/2010 - The description for Bill Type Code 12 was changed
    8/1/2010 - The description for Bill Type Code 13 was changed
    8/1/2010 - The description for Bill Type Code 71 was changed
    8/1/2010 - The description for Bill Type Code 73 was changed
    8/1/2010 - The description for Bill Type Code 85 was changed

    8/1/2010 - The description for Revenue code 0360 was changed
    8/1/2010 - The description for Revenue code 0361 was changed
    8/1/2010 - The description for Revenue code 0369 was changed
    8/1/2010 - The description for Revenue code 0456 was changed
    8/1/2010 - The description for Revenue code 0490 was changed
    8/1/2010 - The description for Revenue code 0499 was changed
    8/1/2010 - The description for Revenue code 0510 was changed
    8/1/2010 - The description for Revenue code 0516 was changed
    8/1/2010 - The description for Revenue code 0520 was changed
    8/1/2010 - The description for Revenue code 0761 was changed
    8/1/2010 - The description for Revenue code 0960 was changed
    8/1/2010 - The description for Revenue code 0969 was changed
    8/1/2010 - The description for Revenue code 0975 was changed
    8/1/2010 - The description for Revenue code 0982 was changed
    8/1/2010 - The description for Revenue code 0983 was changed

    11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
    17003 descriptor was changed in Group 1
    17110 descriptor was changed in Group 1
    17111 descriptor was changed in Group 1 
     
    Reason for Change 
    ICD9 Addition/Deletion
     
    Last Reviewed On Date 
    02/01/2011 
     
    Related Documents 
    Article(s)
    A47397 - Removal of Benign Skin Lesions – Supplemental Instructions Article
     
    LCD Attachments 
    Removal of Benign Skin Lesions - Comment and Response (192,714 bytes)