L29170-LCD

LCD/NCD Portal

Automated World Health

Local Coverage Determination (LCD) for Excision of Malignant Skin Lesions (L29170)

Contractor Information

Contractor Name First Coast Service Options, Inc.

Contractor Number 09102

Contractor Type MAC - Part B

LCD Information

Document Information

LCD ID Number L29170

LCD Title

Excision of Malignant Skin Lesions

Contractor's Determination Number 11600

Primary Geographic Jurisdiction Florida

Oversight Region Region IV

AMA CPT/ADA CDT Copyright Statement

CPT only copyright 2002-2011 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The Code on Dental Procedures and Nomenclature (Code) is published in Current Dental Terminology (CDT). Copyright © American Dental Association. All rights reserved. CDT and CDT-2010 are trademarks of the American Dental Association.

Original Determination Effective Date

For services performed on or after 02/02/2009

Original Determination Ending Date

Revision Effective Date

For services performed on or after 10/01/2011

Revision Ending Date

CMS National Coverage Policy N/A

Indications and Limitations of Coverage and/or Medical Necessity

A skin lesion is any alteration in the normal skin architecture. Lesions can be benign, pre-malignant or malignant. The most common malignant lesions are Basal Cell Carcinomas (BCC), Squamous Cell Carcinomas (SCC) and Melanomas.

Four of the most common methods of treatment of malignant skin lesions are:

- Surgical excision,

- Electrodesccation (tissue destruction by heat),

- Radiation therapy, or

- Cryosurgery (tissue destruction by freezing)

The treatment of choice for malignant skin lesions is complete excision that includes a variable margin of surrounding tissue in order to eradicate microscopic tumor cells, which may have spread beyond the visible borders of the lesion.

Medicare will consider the excision of a malignant skin lesion including margins (procedure codes 11600-11646) medically necessary when a pathology report verifies the existence of a malignancy.

When a lesion is excised that is a neoplasm of uncertain morphology (e.g., melanoma vs. dyplastic nevi), choose the correct CPT code based on the manner in which the lesion is excised rather than the final pathological diagnosis. The CPT code should reflect the knowledge, skill, time and effort that the provider invests in the excision of the lesion. For example, an ambiguous, but low-suspicion lesion might be excised with minimal surrounding, grossly normal skin/soft tissue margins, as for a benign lesion. This would be most appropriately reported using the excision of benign lesion codes 11400-11446. An ambiguous, but moderate to high suspicion lesion would be excised with moderate to wide surrounding grossly normal skin/soft tissue margins, as for a malignant lesion. This type of excision would be most appropriately reported using the excision of malignant lesion including margins codes 11600-11646.

Coding Information

Bill Type Codes:

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

Revenue Codes:

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

99999 Not Applicable

CPT/HCPCS Codes

11600 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 0.5 CM OR LESS

11601 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 0.6 TO 1.0 CM

11602 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 1.1 TO 2.0 CM

11603 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 2.1 TO 3.0 CM

11604 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 3.1 TO 4.0 CM

11606 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER OVER 4.0 CM

11620 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.5 CM OR LESS

11621 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.6 TO 1.0 CM

11622 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 1.1 TO 2.0 CM

11623 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 2.1 TO 3.0 CM

11624 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 3.1 TO 4.0 CM

11626 EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER OVER 4.0 CM

11640 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 0.5 CM OR LESS

11641 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 0.6 TO 1.0 CM

11642 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 1.1 TO 2.0 CM

11643 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 2.1 TO 3.0 CM

11644 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 3.1 TO 4.0 CM

11646 EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER OVER 4.0 CM

ICD-9 Codes that Support Medical Necessity Procedure Codes 11600-11606

172.5 MALIGNANT MELANOMA OF SKIN OF TRUNK EXCEPT SCROTUM

172.6 MALIGNANT MELANOMA OF SKIN OF UPPER LIMB INCLUDING SHOULDER

172.7 MALIGNANT MELANOMA OF SKIN OF LOWER LIMB INCLUDING HIP

173.50 - 173.59

173.60 - 173.69

173.70 - 173.79

UNSPECIFIED MALIGNANT NEOPLASM OF SKIN OF TRUNK, EXCEPT SCROTUM - OTHER SPECIFIED MALIGNANT NEOPLASM OF SKIN OF TRUNK, EXCEPT SCROTUM UNSPECIFIED MALIGNANT NEOPLASM OF SKIN OF UPPER LIMB, INCLUDING SHOULDER

- OTHER SPECIFIED MALIGNANT NEOPLASM OF SKIN OF UPPER LIMB, INCLUDING SHOULDER

UNSPECIFIED MALIGNANT NEOPLASM OF SKIN OF LOWER LIMB, INCLUDING HIP - OTHER SPECIFIED MALIGNANT NEOPLASM OF SKIN OF LOWER LIMB, INCLUDING HIP

195.1 MALIGNANT NEOPLASM OF THORAX

195.2 MALIGNANT NEOPLASM OF ABDOMEN

195.3 MALIGNANT NEOPLASM OF PELVIS

195.4 MALIGNANT NEOPLASM OF UPPER LIMB

195.5 MALIGNANT NEOPLASM OF LOWER LIMB

195.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES

198.2 SECONDARY MALIGNANT NEOPLASM OF SKIN

198.81 SECONDARY MALIGNANT NEOPLASM OF BREAST

232.5 CARCINOMA IN SITU OF SKIN OF TRUNK EXCEPT SCROTUM

232.6 CARCINOMA IN SITU OF SKIN OF UPPER LIMB INCLUDING SHOULDER

232.7 CARCINOMA IN SITU OF SKIN OF LOWER LIMB INCLUDING HIP

232.8 CARCINOMA IN SITU OF OTHER SPECIFIED SITES OF SKIN

238.2 NEOPLASM OF UNCERTAIN BEHAVIOR OF SKIN

Procedure Codes 11620-11626

172.4 MALIGNANT MELANOMA OF SKIN OF SCALP AND NECK

172.6 MALIGNANT MELANOMA OF SKIN OF UPPER LIMB INCLUDING SHOULDER

172.7 MALIGNANT MELANOMA OF SKIN OF LOWER LIMB INCLUDING HIP

173.40 - 173.49

173.60 - 173.69

173.70 - 173.79

UNSPECIFIED MALIGNANT NEOPLASM OF SCALP AND SKIN OF NECK - OTHER SPECIFIED MALIGNANT NEOPLASM OF SCALP AND SKIN OF NECK

UNSPECIFIED MALIGNANT NEOPLASM OF SKIN OF UPPER LIMB, INCLUDING SHOULDER

- OTHER SPECIFIED MALIGNANT NEOPLASM OF SKIN OF UPPER LIMB, INCLUDING SHOULDER

UNSPECIFIED MALIGNANT NEOPLASM OF SKIN OF LOWER LIMB, INCLUDING HIP - OTHER SPECIFIED MALIGNANT NEOPLASM OF SKIN OF LOWER LIMB, INCLUDING HIP

184.1 MALIGNANT NEOPLASM OF VAGINA

184.2 MALIGNANT NEOPLASM OF LABIA MAJORA

184.3 MALIGNANT NEOPLASM OF LABIA MINORA

184.4 MALIGNANT NEOPLASM OF CLITORIS

184.5 MALIGNANT NEOPLASM OF VULVA UNSPECIFIED SITE

184.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF FEMALE GENITAL ORGANS

187.1 MALIGNANT NEOPLASM OF PREPUCE

187.2 MALIGNANT NEOPLASM OF GLANS PENIS

187.3 MALIGNANT NEOPLASM OF BODY OF PENIS

187.4 MALIGNANT NEOPLASM OF PENIS PART UNSPECIFIED

187.7 MALIGNANT NEOPLASM OF SCROTUM

195.0 MALIGNANT NEOPLASM OF HEAD FACE AND NECK

195.3 MALIGNANT NEOPLASM OF PELVIS

195.4 MALIGNANT NEOPLASM OF UPPER LIMB

195.5 MALIGNANT NEOPLASM OF LOWER LIMB

198.2 SECONDARY MALIGNANT NEOPLASM OF SKIN

198.82 SECONDARY MALIGNANT NEOPLASM OF GENITAL ORGANS

232.4 CARCINOMA IN SITU OF SCALP AND SKIN OF NECK

232.6 CARCINOMA IN SITU OF SKIN OF UPPER LIMB INCLUDING SHOULDER

232.7 CARCINOMA IN SITU OF SKIN OF LOWER LIMB INCLUDING HIP

232.8 CARCINOMA IN SITU OF OTHER SPECIFIED SITES OF SKIN

233.30 - 233.39 CARCINOMA IN SITU, UNSPECIFIED FEMALE GENITAL ORGAN - CARCINOMA IN SITU, OTHER FEMALE GENITAL ORGAN

233.5 CARCINOMA IN SITU OF PENIS

233.6 CARCINOMA IN SITU OF OTHER AND UNSPECIFIED MALE GENITAL ORGANS

238.2 NEOPLASM OF UNCERTAIN BEHAVIOR OF SKIN

Procedure Codes 11640-11646

140.0 - 149.9 MALIGNANT NEOPLASM OF UPPER LIP VERMILION BORDER - MALIGNANT NEOPLASM OF ILL-DEFINED SITES WITHIN THE LIP AND ORAL CAVITY

172.1 MALIGNANT MELANOMA OF SKIN OF LIP

172.2 MALIGNANT MELANOMA OF SKIN OF EYELID INCLUDING CANTHUS

172.3 MALIGNANT MELANOMA OF SKIN OF EAR AND EXTERNAL AUDITORY CANAL

172.4 MALIGNANT MELANOMA OF SKIN OF OTHER AND UNSPECIFIED PARTS OF FACE

172.8 MALIGNANT MELANOMA OF OTHER SPECIFIED SITES OF SKIN

173.00 - 173.09

173.10 - 173.19

173.20 - 173.29

173.30 - 173.39

173.80 - 173.89

UNSPECIFIED MALIGNANT NEOPLASM OF SKIN OF LIP - OTHER SPECIFIED MALIGNANT NEOPLASM OF SKIN OF LIP

UNSPECIFIED MALIGNANT NEOPLASM OF EYELID, INCLUDING CANTHUS - OTHER SPECIFIED MALIGNANT NEOPLASM OF EYELID, INCLUDING CANTHUS UNSPECIFIED MALIGNANT NEOPLASM OF SKIN OF EAR AND EXTERNAL AUDITORY

CANAL - OTHER SPECIFIED MALIGNANT NEOPLASM OF SKIN OF EAR AND EXTERNAL AUDITORY CANAL

UNSPECIFIED MALIGNANT NEOPLASM OF SKIN OF OTHER AND UNSPECIFIED PARTS OF FACE - OTHER SPECIFIED MALIGNANT NEOPLASM OF SKIN OF OTHER AND UNSPECIFIED PARTS OF FACE

UNSPECIFIED MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF SKIN - OTHER SPECIFIED MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF SKIN

195.0 MALIGNANT NEOPLASM OF HEAD FACE AND NECK

198.2 SECONDARY MALIGNANT NEOPLASM OF SKIN

230.0 CARCINOMA IN SITU OF LIP ORAL CAVITY AND PHARYNX

232.1 CARCINOMA IN SITU OF SKIN OF LIP

232.2 CARCINOMA IN SITU OF EYELID INCLUDING CANTHUS

232.3 CARCINOMA IN SITU OF SKIN OF EAR AND EXTERNAL AUDITORY CANAL

232.4 CARCINOMA IN SITU OF SKIN OF OTHER AND UNSPECIFIED PARTS OF FACE

232.8 CARCINOMA IN SITU OF OTHER SPECIFIED SITES OF SKIN

238.2 NEOPLASM OF UNCERTAIN BEHAVIOR OF SKIN

Diagnoses that Support Medical Necessity N/A

ICD-9 Codes that DO NOT Support Medical Necessity N/A

XX000 Not Applicable

ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation

Diagnoses that DO NOT Support Medical Necessity N/A

General Information

Documentations Requirements

The medical record/ progress note should indicate the removal of a malignant or an ambiguous, but moderate to high suspicion lesion with a corresponding pathology report. The size and location of the lesion should be

documented in the operative report.

Appendices

Utilization Guidelines It is expected that these services would be performed as indicated by current medical literature and/or standards of practice. When services are performed in excess of established parameters, they may be subject to review for medical necessity.

Sources of Information and Basis for Decision

American Medical Association. (2000). Reviewing of the integumentary excision lesion codes (11400-11646). cptäAssistant, 10(8), 5-7.

Arora, A. & Attwood, J. (2009). Common skin cancers and their precursors. Surgical Clinics of North America 89(3).

Rigel, D.S. & Carucci, J.A. (2000). Malignant melanoma: Prevention, early detection, and treatment in the 21st century. CA: A Cancer Journal for Clinicians [On-Line], 50. Available: http://ca-journal.org/articles/50/4/215- 236/50_215-236.html

Advisory Committee Meeting Notes This Local Coverage Determination (LCD) does not reflect the sole opinion of the contractor or Contractor Medical Director. Although the final decision rests with the contractor, this LCD was

developed in cooperation with advisory groups, which includes representatives from numerous societies.

Start Date of Comment Period

End Date of Comment Period

Start Date of Notice Period 10/01/2009

Revision History Number 2

Revision History Explanation Revision Number:2 Start Date of Comment Period:N/A

Start Date of Notice Period:10/01/2011 Revised Effective Date: 10/01/2011

LCR B2011-101

September 2011 Connection

Explanation of Revision: Annual 2012 ICD-9-CM Update. For CPT codes 11600-11606 deleted diagnosis codes 173.5, 173.6, and 173.7. Added new diagnosis codes 173.50-173.59, 173.60-173.69 and 173.70-173.79. For

CPT codes 11620-11626 deleted diagnosis codes 173.4, 173.6 and 173.7. Added new diagnosis codes 173.40-

173.49, 173.60-173.69 and 173.70-173.79. For CPT codes 11640-11646 deleted diagnosis codes 173.0, 173.1,

173.2, 173.3 and 173.8. Added new diagnosis codes 173.00-173.09, 173.10-173.19, 173.20-173.29, 173.30-

173.39 and 173.80-173.89. The effective date of this revision is based on date of service.

Revision Number:1

Start Date of Comment Period:N/A Start Date of Notice Period:10/01/2009 Revised Effective Date:08/28/2009

LCR B2009-091

September 2009 Update

Explanation of Revision: Under the “ICD-9 Codes that Support Medical Necessity” section for procedure code range 11640-11646, added ICD-9-CM code 198.2. In addition, updated the “Sources of Information and Basis for Decision” section. The effective date of this revision is for claims processed on or after 08/28/2009 for dates of service on or after 02/02/2009 for Florida and for dates of service on or after 03/02/2009 for Puerto Rico/Virgin Islands.

Revision Number:Original

Start Date of Comment Period:N/A Start Date of Notice Period:12/04/2008 Revised Effective Date:02/02/2009

LCR B2009-

December 2008 Bulletin

This LCD consolidates and replaces all previous policies and publications on this subject by the carrier predecessors of First Coast Service Options, Inc. (Triple S and FCSO).

For Florida (00590) this LCD (L29170) replaces LCD L6490 as the policy in notice. This document (L29170) is effective on 02/02/2009.

08/27/2011 - This policy was updated by the ICD-9 2011-2012 Annual Update.

11/21/2011 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:

11600 descriptor was changed in Group 1 11601 descriptor was changed in Group 1 11602 descriptor was changed in Group 1 11603 descriptor was changed in Group 1 11604 descriptor was changed in Group 1 11606 descriptor was changed in Group 1 11620 descriptor was changed in Group 1 11621 descriptor was changed in Group 1 11622 descriptor was changed in Group 1 11623 descriptor was changed in Group 1 11624 descriptor was changed in Group 1 11626 descriptor was changed in Group 1 11640 descriptor was changed in Group 1 11641 descriptor was changed in Group 1 11642 descriptor was changed in Group 1 11643 descriptor was changed in Group 1 11644 descriptor was changed in Group 1 11646 descriptor was changed in Group 1

Reason for Change