Notification



Notification Issue Date:



Policy Attachment


Attachment to Policy # 11.08.01f


Attachment:A

Policy #:11.08.01f

Description:ICD-10-CM codes

Title:Hair Transplants and Cranial Prostheses (Wigs)


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.



L59.9 Disorder of the skin and subcutaneous tissue related to radiation, unspecified

L63.0 Alopecia (capitis) totalis

L63.1 Alopecia universalis

L63.2 Ophiasis

L63.8 Other alopecia areata

L63.9 Alopecia areata, unspecified

L64.0 Drug-induced androgenic alopecia

L65.0 Telogen effluvium

L65.1 Anagen effluvium

L65.2 Alopecia mucinosa

L65.8 Other specified nonscarring hair loss

L65.9 Nonscarring hair loss, unspecified

L66.0 Pseudopelade

L66.2 Folliculitis decalvans

L66.8 Other cicatricial alopecia

L66.9 Cicatricial alopecia, unspecified

S01.00XA Unspecified open wound of scalp, initial encounter

S01.00XD Unspecified open wound of scalp, subsequent encounter

S01.00XS Unspecified open wound of scalp, sequela

S01.01XA Laceration without foreign body of scalp, initial encounter

S01.01XD Laceration without foreign body of scalp, subsequent encounter

S01.01XS Laceration without foreign body of scalp, sequela

S01.02XA Laceration with foreign body of scalp, initial encounter

S01.02XD Laceration with foreign body of scalp, subsequent encounter

S01.02XS Laceration with foreign body of scalp, sequela

S01.03XA Puncture wound without foreign body of scalp, initial encounter

S01.03XD Puncture wound without foreign body of scalp, subsequent encounter

S01.03XS Puncture wound without foreign body of scalp, sequela

S01.04XA Puncture wound with foreign body of scalp, initial encounter

S01.04XD Puncture wound with foreign body of scalp, subsequent encounter

S01.04XS Puncture wound with foreign body of scalp, sequela

S01.05XA Open bite of scalp, initial encounter

S01.05XD Open bite of scalp, subsequent encounter

S01.05XS Open bite of scalp, sequela

S08.0XXA Avulsion of scalp, initial encounter

S08.0XXD Avulsion of scalp, subsequent encounter

S08.0XXS Avulsion of scalp, sequela

S09.8XXA Other specified injuries of head, initial encounter

S09.8XXD Other specified injuries of head, subsequent encounter

S09.8XXS Other specified injuries of head, sequela

S09.90XA Unspecified injury of head, initial encounter

S09.90XD Unspecified injury of head, subsequent encounter

S09.90XS Unspecified injury of head, sequela

T20.00XA Burn of unspecified degree of head, face, and neck, unspecified site, initial encounter

T20.00XD Burn of unspecified degree of head, face, and neck, unspecified site, subsequent encounter

T20.00XS Burn of unspecified degree of head, face, and neck, unspecified site, sequela

T20.05XA Burn of unspecified degree of scalp [any part], initial encounter

T20.05XD Burn of unspecified degree of scalp [any part], subsequent encounter

T20.05XS Burn of unspecified degree of scalp [any part], sequela

T20.09XA Burn of unspecified degree of multiple sites of head, face, and neck, initial encounter

T20.09XD Burn of unspecified degree of multiple sites of head, face, and neck, subsequent encounter

T20.09XS Burn of unspecified degree of multiple sites of head, face, and neck, sequela

T20.10XA Burn of first degree of head, face, and neck, unspecified site, initial encounter

T20.10XD Burn of first degree of head, face, and neck, unspecified site, subsequent encounter

T20.10XS Burn of first degree of head, face, and neck, unspecified site, sequela

T20.15XA Burn of first degree of scalp [any part], initial encounter

T20.15XD Burn of first degree of scalp [any part], subsequent encounter

T20.15XS Burn of first degree of scalp [any part], sequela

T20.19XA Burn of first degree of multiple sites of head, face, and neck, initial encounter

T20.19XD Burn of first degree of multiple sites of head, face, and neck, subsequent encounter

T20.19XS Burn of first degree of multiple sites of head, face, and neck, sequela

T20.20XA Burn of second degree of head, face, and neck, unspecified site, initial encounter

T20.20XD Burn of second degree of head, face, and neck, unspecified site, subsequent encounter

T20.20XS Burn of second degree of head, face, and neck, unspecified site, sequela

T20.25XA Burn of second degree of scalp [any part], initial encounter

T20.25XD Burn of second degree of scalp [any part], subsequent encounter

T20.25XS Burn of second degree of scalp [any part], sequela

T20.29XA Burn of second degree of multiple sites of head, face, and neck, initial encounter

T20.29XD Burn of second degree of multiple sites of head, face, and neck, subsequent encounter

T20.29XS Burn of second degree of multiple sites of head, face, and neck, sequela

T20.30XA Burn of third degree of head, face, and neck, unspecified site, initial encounter

T20.30XD Burn of third degree of head, face, and neck, unspecified site, subsequent encounter

T20.30XS Burn of third degree of head, face, and neck, unspecified site, sequela

T20.35XA Burn of third degree of scalp [any part], initial encounter

T20.35XD Burn of third degree of scalp [any part], subsequent encounter

T20.35XS Burn of third degree of scalp [any part], sequela

T20.39XA Burn of third degree of multiple sites of head, face, and neck, initial encounter

T20.39XD Burn of third degree of multiple sites of head, face, and neck, subsequent encounter

T20.39XS Burn of third degree of multiple sites of head, face, and neck, sequela

T20.40XA Corrosion of unspecified degree of head, face, and neck, unspecified site, initial encounter

T20.40XD Corrosion of unspecified degree of head, face, and neck, unspecified site, subsequent encounter

T20.40XS Corrosion of unspecified degree of head, face, and neck, unspecified site, sequela

T20.45XA Corrosion of unspecified degree of scalp [any part], initial encounter

T20.45XD Corrosion of unspecified degree of scalp [any part], subsequent encounter

T20.45XS Corrosion of unspecified degree of scalp [any part], sequela

T20.49XA Corrosion of unspecified degree of multiple sites of head, face, and neck, initial encounter

T20.49XD Corrosion of unspecified degree of multiple sites of head, face, and neck, subsequent encounter

T20.49XS Corrosion of unspecified degree of multiple sites of head, face, and neck, sequela

T20.50XA Corrosion of first degree of head, face, and neck, unspecified site, initial encounter

T20.50XD Corrosion of first degree of head, face, and neck, unspecified site, subsequent encounter

T20.50XS Corrosion of first degree of head, face, and neck, unspecified site, sequela

T20.55XA Corrosion of first degree of scalp [any part], initial encounter

T20.55XD Corrosion of first degree of scalp [any part], subsequent encounter

T20.55XS Corrosion of first degree of scalp [any part], sequela

T20.59XA Corrosion of first degree of multiple sites of head, face, and neck, initial encounter

T20.59XD Corrosion of first degree of multiple sites of head, face, and neck, subsequent encounter

T20.59XS Corrosion of first degree of multiple sites of head, face, and neck, sequela

T20.60XA Corrosion of second degree of head, face, and neck, unspecified site, initial encounter

T20.60XD Corrosion of second degree of head, face, and neck, unspecified site, subsequent encounter

T20.60XS Corrosion of second degree of head, face, and neck, unspecified site, sequela

T20.65XA Corrosion of second degree of scalp [any part], initial encounter

T20.65XD Corrosion of second degree of scalp [any part], subsequent encounter

T20.65XS Corrosion of second degree of scalp [any part], sequela

T20.69XA Corrosion of second degree of multiple sites of head, face, and neck, initial encounter

T20.69XD Corrosion of second degree of multiple sites of head, face, and neck, subsequent encounter

T20.69XS Corrosion of second degree of multiple sites of head, face, and neck, sequela

T20.70XA Corrosion of third degree of head, face, and neck, unspecified site, initial encounter

T20.70XD Corrosion of third degree of head, face, and neck, unspecified site, subsequent encounter

T20.70XS Corrosion of third degree of head, face, and neck, unspecified site, sequela

T20.75XA Corrosion of third degree of scalp [any part], initial encounter

T20.75XD Corrosion of third degree of scalp [any part], subsequent encounter

T20.75XS Corrosion of third degree of scalp [any part], sequela

T20.79XA Corrosion of third degree of multiple sites of head, face, and neck, initial encounter

T20.79XD Corrosion of third degree of multiple sites of head, face, and neck, subsequent encounter

T20.79XS Corrosion of third degree of multiple sites of head, face, and neck, sequela

T66.XXXA Radiation sickness, unspecified, initial encounter

T66.XXXD Radiation sickness, unspecified, subsequent encounter

T66.XXXS Radiation sickness, unspecified, sequela

THE FOLLOWING DIAGNOSIS CODE IS CONSIDERED A BENEFIT CONTRACT EXCLUSION

Z41.1 Encounter for cosmetic surgery

Version Effective Date: 05/03/2017
Version Issued Date: 05/03/2017
Version Reissued Date: 03/28/2018

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