Destruction of premalignant lesion

smartcoder

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Can destuction of actinic porokeratosis (692.75) be billed as destuction of pre-malignant lesion (17000-17004)?

As per my experience and also by Inga Ellzey, this diagnosis (692.75) is considered as benign or non-premalignant by insurance and would not pay on it unless it is billed as destruction of benign lesion (17110 and 17111). Aslo for destruction of premalignant lesion (17000, 17003 and 17004) the primary diagnosis code must always be 702.0.

Please advice. Thanks !!
 
Last edited:

peachygirl

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Hello,
Medicare will cover removal of DSAP using the benign dest codes 17110, 17111--the dx 692.75 was added to the list I of covered diagnoses. You are correct with ak's, they are currently the only covered dx codes for pre-malig dest 17000-17004.

See Medicare LCD L10106:
3. We received a single request that we add ICD-9 692.75 Disseminated superficial actinic porokeratosis (DSAP). This condition is purported in the literature to have a high rate of malignant degeneration. We had not previously received such a request, but though we believe removal of these lesions should generally not be undertaken absent some complicating factor such as inflammation, NAS has decided to add the code to List I of the LCD. We will monitor its use and will consider moving it to List II in the future, depending on utilization and literature.

Hope that helps!
Mallory, CPC, CPCD
 
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