Notification



Notification Issue Date:



Policy Attachment


Attachment to Policy # 11.08.23j


Attachment:A

Policy #:11.08.23j

Description:ICD 10 Codes

Title:Mohs' Micrographic Surgery



PROCEDURE CODES 17311, 17312, 17313, 17314, 17315 ARE MEDICALLY NECESSARY WHEN REPORTED WITH THE FOLLOWING DIAGNOSIS CODES

C00.0 Malignant neoplasm of external upper lip

C00.1 Malignant neoplasm of external lower lip

C00.2 Malignant neoplasm of external lip, unspecified

C00.3 Malignant neoplasm of upper lip, inner aspect

C00.4 Malignant neoplasm of lower lip, inner aspect

C00.5 Malignant neoplasm of lip, unspecified, inner aspect

C00.6 Malignant neoplasm of commissure of lip, unspecified

C00.8 Malignant neoplasm of overlapping sites of lip

C00.9 Malignant neoplasm of lip, unspecified

C32.0 Malignant neoplasm of glottis

C32.1 Malignant neoplasm of supraglottis

C32.2 Malignant neoplasm of subglottis

C32.3 Malignant neoplasm of laryngeal cartilage

C32.8 Malignant neoplasm of overlapping sites of larynx

C32.9 Malignant neoplasm of larynx, unspecified

C43.0 Malignant melanoma of lip

C43.10 Malignant melanoma of unspecified eyelid, including canthus

C43.111 Malignant melanoma of right upper eyelid, including canthus

C43.112 Malignant melanoma of right lower eyelid, including canthus

C43.121 Malignant melanoma of left upper eyelid, including canthus

C43.122 Malignant melanoma of left lower eyelid, including canthus

C43.20 Malignant melanoma of unspecified ear and external auricular canal

C43.21 Malignant melanoma of right ear and external auricular canal

C43.22 Malignant melanoma of left ear and external auricular canal

C43.30 Malignant melanoma of unspecified part of face

C43.31 Malignant melanoma of nose

C43.39 Malignant melanoma of other parts of face

C43.4 Malignant melanoma of scalp and neck

C43.51 Malignant melanoma of anal skin

C43.52 Malignant melanoma of skin of breast

C43.59 Malignant melanoma of other part of trunk

C43.60 Malignant melanoma of unspecified upper limb, including shoulder

C43.61 Malignant melanoma of right upper limb, including shoulder

C43.62 Malignant melanoma of left upper limb, including shoulder

C43.70 Malignant melanoma of unspecified lower limb, including hip

C43.71 Malignant melanoma of right lower limb, including hip

C43.72 Malignant melanoma of left lower limb, including hip

C43.8 Malignant melanoma of overlapping sites of skin

C43.9 Malignant melanoma of skin, unspecified

C4A.0 Merkel cell carcinoma of lip

C4A.10 Merkel cell carcinoma of unspecified eyelid, including canthus

C4A.111 Merkel cell carcinoma of right upper eyelid, including canthus

C4A.112 Merkel cell carcinoma of right lower eyelid, including canthus

C4A.121 Merkel cell carcinoma of left upper eyelid, including canthus

C4A.122 Merkel cell carcinoma of left lower eyelid, including canthus

C4A.20 Merkel cell carcinoma of unspecified ear and external auricular canal

C4A.21 Merkel cell carcinoma of right ear and external auricular canal

C4A.22 Merkel cell carcinoma of left ear and external auricular canal C4A.30 Merkel cell carcinoma of unspecified part of face

C4A.31 Merkel cell carcinoma of nose

C4A.39 Merkel cell carcinoma of other parts of face

C4A.4 Merkel cell carcinoma of scalp and neck

C4A.51 Merkel cell carcinoma of anal skin

C4A.52 Merkel cell carcinoma of skin of breast

C4A.59 Merkel cell carcinoma of other part of trunk

C4A.60 Merkel cell carcinoma of unspecified upper limb, including shoulder

C4A.61 Merkel cell carcinoma of right upper limb, including shoulder

C4A.62 Merkel cell carcinoma of left upper limb, including shoulder

C4A.70 Merkel cell carcinoma of unspecified lower limb, including hip

C4A.71 Merkel cell carcinoma of right lower limb, including hip

C4A.72 Merkel cell carcinoma of left lower limb, including hip

C4A.8 Merkel cell carcinoma of overlapping sites

C4A.9 Merkel cell carcinoma, unspecified

C44.01 Basal cell carcinoma of skin of lip

C44.02 Squamous cell carcinoma of skin of lip

C44.09 Other specified malignant neoplasm of skin of lip

C44.111 Basal cell carcinoma of skin of unspecified eyelid, including canthus

C44.1121 Basal cell carcinoma of skin of right upper eyelid, including canthus

C44.1122 Basal cell carcinoma of skin of right lower eyelid, including canthus

C44.1191 Basal cell carcinoma of skin of left upper eyelid, including canthus

C44.1192 Basal cell carcinoma of skin of left lower eyelid, including canthus

C44.121 Squamous cell carcinoma of skin of unspecified eyelid, including canthus

C44.1221 Squamous cell carcinoma of skin of right upper eyelid, including canthus

C44.1222 Squamous cell carcinoma of skin of right lower eyelid, including canthus

C44.1291 Squamous cell carcinoma of skin of left upper eyelid, including canthus

C44.1292 Squamous cell carcinoma of skin of left lower eyelid, including canthus

C44.131 Sebaceous cell carcinoma of skin of unspecified eyelid, including canthus

C44.1321 Sebaceous cell carcinoma of skin of right upper eyelid, including canthus

C44.1322 Sebaceous cell carcinoma of skin of right lower eyelid, including canthus

C44.1391 Sebaceous cell carcinoma of skin of left upper eyelid, including canthus

C44.1392 Sebaceous cell carcinoma of skin of left lower eyelid, including canthus

C44.191 Other specified malignant neoplasm of skin of unspecified eyelid, including canthus

C44.1921 Other specified malignant neoplasm of skin of right upper eyelid, including canthus

C44.1922 Other specified malignant neoplasm of skin of right lower eyelid, including canthus

C44.1991 Other specified malignant neoplasm of skin of left upper eyelid, including canthus

C44.1992 Other specified malignant neoplasm of skin of left lower eyelid, including canthus

C44.211 Basal cell carcinoma of skin of unspecified ear and external auricular canal

C44.212 Basal cell carcinoma of skin of right ear and external auricular canal

C44.219 Basal cell carcinoma of skin of left ear and external auricular canal

C44.221 Squamous cell carcinoma of skin of unspecified ear and external auricular canal

C44.222 Squamous cell carcinoma of skin of right ear and external auricular canal

C44.229 Squamous cell carcinoma of skin of left ear and external auricular canal

C44.291 Other specified malignant neoplasm of skin of unspecified ear and external auricular canal

C44.292 Other specified malignant neoplasm of skin of right ear and external auricular canal

C44.299 Other specified malignant neoplasm of skin of left ear and external auricular canal

C44.310 Basal cell carcinoma of skin of unspecified parts of face

C44.311 Basal cell carcinoma of skin of nose

C44.319 Basal cell carcinoma of skin of other parts of face

C44.320 Squamous cell carcinoma of skin of unspecified parts of face

C44.321 Squamous cell carcinoma of skin of nose

C44.329 Squamous cell carcinoma of skin of other parts of face

C44.390 Other specified malignant neoplasm of skin of unspecified parts of face

C44.391 Other specified malignant neoplasm of skin of nose

C44.399 Other specified malignant neoplasm of skin of other parts of face

C44.41 Basal cell carcinoma of skin of scalp and neck

C44.42 Squamous cell carcinoma of skin of scalp and neck

C44.49 Other specified malignant neoplasm of skin of scalp and neck

C44.510 Basal cell carcinoma of anal skin

C44.511 Basal cell carcinoma of skin of breast

C44.519 Basal cell carcinoma of skin of other part of trunk

C44.520 Squamous cell carcinoma of anal skin

C44.521 Squamous cell carcinoma of skin of breast

C44.529 Squamous cell carcinoma of skin of other part of trunk

C44.590 Other specified malignant neoplasm of anal skin

C44.591 Other specified malignant neoplasm of skin of breast

C44.599 Other specified malignant neoplasm of skin of other part of trunk

C44.611 Basal cell carcinoma of skin of unspecified upper limb, including shoulder

C44.612 Basal cell carcinoma of skin of right upper limb, including shoulder

C44.619 Basal cell carcinoma of skin of left upper limb, including shoulder

C44.621 Squamous cell carcinoma of skin of unspecified upper limb, including shoulder

C44.622 Squamous cell carcinoma of skin of right upper limb, including shoulder

C44.629 Squamous cell carcinoma of skin of left upper limb, including shoulder

C44.691 Other specified malignant neoplasm of skin of unspecified upper limb, including shoulder

C44.692 Other specified malignant neoplasm of skin of right upper limb, including shoulder

C44.699 Other specified malignant neoplasm of skin of left upper limb, including shoulder

C44.711 Basal cell carcinoma of skin of unspecified lower limb, including hip

C44.712 Basal cell carcinoma of skin of right lower limb, including hip

C44.719 Basal cell carcinoma of skin of left lower limb, including hip

C44.721 Squamous cell carcinoma of skin of unspecified lower limb, including hip

C44.722 Squamous cell carcinoma of skin of right lower limb, including hip

C44.729 Squamous cell carcinoma of skin of left lower limb, including hip

C44.791 Other specified malignant neoplasm of skin of unspecified lower limb, including hip

C44.792 Other specified malignant neoplasm of skin of right lower limb, including hip

C44.799 Other specified malignant neoplasm of skin of left lower limb, including hip

C44.81 Basal cell carcinoma of overlapping sites of skin

C44.82 Squamous cell carcinoma of overlapping sites of skin

C44.89 Other specified malignant neoplasm of overlapping sites of skin

C44.91 Basal cell carcinoma of skin, unspecified

C44.92 Squamous cell carcinoma of skin, unspecified

C44.99 Other specified malignant neoplasm of skin, unspecified

C49.0 Malignant neoplasm of connective and soft tissue of head, face and neck

C49.10 Malignant neoplasm of connective and soft tissue of unspecified upper limb, including shoulder

C49.11 Malignant neoplasm of connective and soft tissue of right upper limb, including shoulder(

C49.12 Malignant neoplasm of connective and soft tissue of left upper limb, including shoulder

C49.20 Malignant neoplasm of connective and soft tissue of unspecified lower limb, including hip

C49.21 Malignant neoplasm of connective and soft tissue of right lower limb, including hip

C49.22 Malignant neoplasm of connective and soft tissue of left lower limb, including hip

C49.3 Malignant neoplasm of connective and soft tissue of thorax

C49.4 Malignant neoplasm of connective and soft tissue of abdomen

C49.5 Malignant neoplasm of connective and soft tissue of pelvis

C49.6 Malignant neoplasm of connective and soft tissue of trunk, unspecified

C49.8 Malignant neoplasm of overlapping sites of connective and soft tissue

C49.9 Malignant neoplasm of connective and soft tissue, unspecified

C51.0 Malignant neoplasm of labium majus

C51.1 Malignant neoplasm of labium minus

C51.2 Malignant neoplasm of clitoris

C51.8 Malignant neoplasm of overlapping sites of vulva

C51.9 Malignant neoplasm of vulva, unspecified

C57.7 Malignant neoplasm of other specified female genital organs

C57.8 Malignant neoplasm of overlapping sites of female genital organs

C57.9 Malignant neoplasm of female genital organ, unspecified

C60.0 Malignant neoplasm of prepuce

C60.1 Malignant neoplasm of glans penis

C60.2 Malignant neoplasm of body of penis

C60.8 Malignant neoplasm of overlapping sites of penis

C60.9 Malignant neoplasm of penis, unspecified

C63.2 Malignant neoplasm of scrotum

C63.7 Malignant neoplasm of other specified male genital organs

C63.8 Malignant neoplasm of overlapping sites of male genital organs

C63.9 Malignant neoplasm of male genital organ, unspecified

D03.0 Melanoma in situ of lip

D03.10 Melanoma in situ of unspecified eyelid, including canthus

D03.111 Melanoma in situ of right upper eyelid, including canthus

D03.112 Melanoma in situ of right lower eyelid, including canthus

D03.121 Melanoma in situ of left upper eyelid, including canthus

D03.122 Melanoma in situ of left lower eyelid, including canthus

D03.20 Melanoma in situ of unspecified ear and external auricular canal

D03.21 Melanoma in situ of right ear and external auricular canal

D03.22 Melanoma in situ of left ear and external auricular canal

D03.30 Melanoma in situ of unspecified part of face

D03.39 Melanoma in situ of other parts of face

D03.4 Melanoma in situ of scalp and neck

D03.51 Melanoma in situ of anal skin

D03.52 Melanoma in situ of breast (skin) (soft tissue)

D03.59 Melanoma in situ of other part of trunk

D03.60 Melanoma in situ of unspecified upper limb, including shoulder

D03.61 Melanoma in situ of right upper limb, including shoulder

D03.62 Melanoma in situ of left upper limb, including shoulder

D03.70 Melanoma in situ of unspecified lower limb, including hip

D03.71 Melanoma in situ of right lower limb, including hip

D03.72 Melanoma in situ of left lower limb, including hip

D03.8 Melanoma in situ of other sites

D03.9 Melanoma in situ, unspecified

D04.0 Carcinoma in situ of skin of lip

D04.10 Carcinoma in situ of skin of unspecified eyelid, including canthus

D04.111 Carcinoma in situ of skin of right upper eyelid, including canthus

D04.112 Carcinoma in situ of skin of right lower eyelid, including canthus

D04.121 Carcinoma in situ of skin of left upper eyelid, including canthus

D04.122 Carcinoma in situ of skin of left lower eyelid, including canthus

D04.20 Carcinoma in situ of skin of unspecified ear and external auricular canal

D04.21 Carcinoma in situ of skin of right ear and external auricular canal

D04.22 Carcinoma in situ of skin of left ear and external auricular canal

D04.30 Carcinoma in situ of skin of unspecified part of face

D04.39 Carcinoma in situ of skin of other parts of face

D04.4 Carcinoma in situ of skin of scalp and neck

D04.5 Carcinoma in situ of skin of trunk

D04.60 Carcinoma in situ of skin of unspecified upper limb, including shoulder

D04.61 Carcinoma in situ of skin of right upper limb, including shoulder

D04.62 Carcinoma in situ of skin of left upper limb, including shoulder

D04.70 Carcinoma in situ of skin of unspecified lower limb, including hip

D04.71 Carcinoma in situ of skin of right lower limb, including hip

D04.72 Carcinoma in situ of skin of left lower limb, including hip

D04.8 Carcinoma in situ of skin of other sites

D04.9 Carcinoma in situ of skin, unspecified

D07.1 Carcinoma in situ of vulva

D07.2 Carcinoma in situ of vagina

D07.30 Carcinoma in situ of unspecified female genital organs

D07.39 Carcinoma in situ of other female genital organs

D07.4 Carcinoma in situ of penis

D07.60 Carcinoma in situ of unspecified male genital organs

D07.61 Carcinoma in situ of scrotum

D07.69 Carcinoma in situ of other male genital organs

D48.1 Neoplasm of uncertain behavior of connective and other soft tissue

D48.5 Neoplasm of uncertain behavior of skin

Version Effective Date: 10/01/2018
Version Issued Date: 10/01/2018
Version Reissued Date: 10/11/2018

Connect with Us        


2017 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.