Skip to main content

Skin Exam Screenings: To Code or Not to Code

Inga C. Ellzey, RHIA, MPA, CDC

By October 5, 2022April 20th, 2023No Comments

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.


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!


Personal history of malignant melanoma of skin


Personal history of Merkel cell carcinoma


Personal history of in-situ neoplasm of other site


Personal history of other benign neoplasm


Personal history of diseases of the skin and subcutaneous tissue


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

Read more from our published resources:
Telehealth Services:  Place of Service Update
Fee Schedule: What to expect in 2023

About Inga Ellzey and our Dermatology Billing Services

After 27 years of perfecting billing processes, Inga Ellzey continues to be the nation’s leading expert in dermatology billing. Our billing service serves over 100 dermatology practices in 37 states without utilizing any offshore labor. Our goal is to make sure that you and your patients receive the most competent and professional service available on the market today.

If you are interested in speaking with our company about how we can maximize your collections while also improving your process, please contact us or call 888-434-4374.

Leave a Reply