Wiki Icd v49.89

[susie09]

Hello,
can anybody tell me what health conditions Medicare is looking for in order to use this as a secondary DX for lesion removal.
thanks

 

[kb26coder]

Hi Susie...this info comes from the CMS website and should hopefully help you out. Here's the full-length link if you want to read more: http://www.cms.gov/medicare-coverag...itle&KeyWordSearchType=And&bc=gAAAABAAAAAA&#0

SKIN LESIONS

Benign skin lesions are common in the elderly and are frequently removed at the patient's request to improve appearance. Removal of benign skin lesions that do not pose a threat to health or function is considered cosmetic and as such is not covered by the Medicare program.

Medicare will consider the removal of benign skin lesions as medically necessary, and not cosmetic, if one or more of the following conditions is present and clearly documented in the medical record:

A. The lesion has one or more of the following characteristics:
1. bleeding
2. intense itching
3. pain

B. The lesion has physical evidence of inflammation, e.g.; purulence, oozing, edema, erythema, etc.

C. The lesion obstructs an orifice or clinically restricts vision.

D. The clinical diagnosis is uncertain, particularly where malignancy is a realistic consideration based on lesional appearance (e.g. non-response to conventional treatment, or change in appearance). However, if the diagnosis is uncertain, either biopsy or removal may be more prudent than destruction.

E. A prior biopsy suggests or is indicative of lesion malignancy.

F. The lesion is in an anatomical region subject to recurrent physical trauma and there is documentation that such trauma has in fact resulted in pain, itching or bleeding.

G. Wart removals will be covered under (A) through (F) above. In addition, wart destruction will be covered when the following clinical circumstance is present:

● Periocular warts associated with chronic recurrent conjunctivitis thought secondary to lesional virus shedding

● Warts showing evidence of spread from one body area to another, particularly in immunocompromised/immunosuppressed patients.

H. Providers are reminded that ICD-9-CM 706.2 Sebaceous cyst is included in both List I and List II. Note that the code is accompanied by an asterisk (*) and a description addendum noting parameters of coverage for removal. If the cyst is greater than 2.0 cm in diameter, no secondary diagnosis is required. On the other hand, if the lesion is 2.0 cm or less, List II requirements must be met in order to support coverage and payment.

Benign skin lesion removals for reasons other than those given above are considered to be cosmetic and will not be covered. These reasons include, but are not limited to, emotional distress, "makeup trapping," and clearly benign lesions lacking any component of functional compromise in any anatomic location.

 

[susie09]

Great, thank you, Kari