Squamous Cell Carcinoma ICD-10-CM Coding
by John Verhovshek, MA, CPC
Squamous cell carcinoma (SCC) is the second most common type of skin cancer. It begins in the squamous cells, which comprise most of the skin’s epidermis. SCCs often occur on the sun-exposed areas of the body, such as the rim of the ear, lower lip, face, bald scalp, neck, hands, arms, and legs. Signs and symptoms of SCCs include:
- Rough feeling bump or lump on skin
- Dome-shaped or crusty lesion that may bleed
- Sore that doesn’t heal
- Flat, reddish, scaly patch that grows slowly
- Lump under nail
Squamous cell carcinoma is most commonly seen in fair-skinned people who have spent extended time in the sun. Other risk factors for SCC include:
- Blue or green eyed people with blond or red hair
- Long-term daily sun exposure, as with people that work outdoors with no sun protection or covering up
- Many severe sunburns early in life
- Older age. The older a person, the longer sun exposure they have had
- Overexposure or long-term exposure to X-rays
- Chemical exposures, such as arsenic in drinking water, tar, or working with insecticides or herbicides.
- Tanning bed use. According to the Skin Cancer Foundation, 170,000 cases of non-melanoma skin cancer in the US each year are associated with indoor tanning. Use of indoor UV tanning equipment increases a person’s risk of developing squamous cell carcinoma by 67 percent.
To assign the most appropriate ICD-10-CM code for squamous cell carcinoma, clinical documentation should indicate:
- Whether the site is primary, secondary, or carcinoma in situ. Without further definition, if the term SCC or squamous cell carcinoma is used, it is understood to be a primary site.
- Site on the skin (e.g., trunk, upper limb, or lower limb)
- Laterality (e.g., right or left)
- Any personal or family history of skin cancer or current or history of smoking or smoke exposure should also be documented and reported.
ICD-10-CM chapter 2 contains codes for most benign and malignant neoplasms. As in ICD-9-CM, there is a separate Table of Neoplasms. Codes should be selected from the table. It is important to remember when accessing the Neoplasm Table, to look under the main term Skin, first, then drop to the body part, to locate the appropriate code.
The codes for squamous cell carcinoma are under category C44 Other and unspecified malignant neoplasm of skin. Codes with a subcategory listing further specify laterality.
C44.02 Squamous cell carcinoma of skin of lip
C44.12- Squamous cell carcinoma of skin of eyelid, including canthus
C44.22- Squamous cell carcinoma of skin of ear and external auricular canal
C44.32- Squamous cell carcinoma of skin of other an unspecified parts of face
C44.42 Squamous cell carcinoma of skin of scalp and neck
C44.52- Squamous cell carcinoma of skin of trunk
C44.62- Squamous cell carcinoma of skin of upper limb, including shoulder’
C44.72- Squamous cell carcinoma of skin of lower limb, including hip
C44.82 Squamous cell carcinoma of overlapping sites of skin
C44.92 Squamous cell carcinoma of skin, unspecified
Example 1: A patient returns to the dermatologist to discuss removal of his SCC on his lower lip. Proper coding is C44.02 Squamous cell carcinoma of skin of lip.
Example 2: A patient has a suspicious lesion removed from the back of his right hand. The patient is informed that the biopsy results confirm squamous cell carcinoma. Proper coding is C44.622 Squamous cell carcinoma of skin of right upper limb, including shoulder.