In Dermatology, regular skin exams are medically necessary for patients with history of skin cancer. At first glance, ICD-10 code Z12.83 seems to be the perfect code to append to these visits; however, one needs to look closer at carrier guidelines for routine skin exams.
Z12.83 | Encounter for screening for malignant neoplasm of skin |
“Screening” is the issue in that definition!
Dermatology is a problem-oriented specialty. Many carriers, including Medicare, do not permit dermatologists to perform preventive visits or wellness exams, even if they are for a screening of malignant neoplasms. Preventive/screening visits are typically performed by Family Practitioners, OBGYNs, and Internal Medicine specialists.
Medicare has a list of covered “screening” services and skin exams are not on the list.
So how do we code these routine screening skin exam visits?
You are be better off using a personal history of skin cancer code (if it exists for the patient) or coding the encounter based on conditions discovered during the exam, even if asymptomatic or not requiring treatment. Perhaps the patient has Xerosis, some normal looking melanocytic nevi, and a skin tag or two. Code those!
Z85.820 | Personal history of malignant melanoma of skin |
Z85.821 | Personal history of Merkel cell carcinoma |
Z86.008 | Personal history of in-situ neoplasm of other site |
Z86.018 | Personal history of other benign neoplasm |
Z87.2 | Personal history of diseases of the skin and subcutaneous tissue |
Z85.828 | Personal history of other malignant neoplasm of skin |
What if the patient has no history of skin cancer?
Code what you found during the full body skin exam. For example, the patient may have many benign nevi (D22.0-D22.9), skin tags (L91.8), Actinic Keratosis (L57.0), Seborrheic Keratosis (L82.0-L82.1) that you council the patient on and advise monitoring.
Keep in mind that if you perform a procedure on the AK’s, SK’s or tags on the same day of the evaluation, the decision to do the procedure does not support an EM-25 as it is included in the minor procedure.
An example of when an EM is supported separate from a procedure on the same date of service:
A patient comes in with an itchy, growing lesion on her chest and complains of recurrent acne on her forehead she has experienced for years. You evaluate both and prescribe Clindamycin for the acne and shave remove the Seborrheic Keratosis on her chest. The evaluation and prescription for the Acne supports an EM separate from the procedure.
Currently, our experience is that Z12.83 will be denied as “preventive” by the major carriers and we suggest not to use this code on your claims.
Source: MLN Matters
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