Dermatology medical billing is complex by virtue of the diversity of procedures, ranging from minor skin examinations to complex surgical and cosmetic procedures. The most daunting challenge is correctly identifying medically necessary procedures versus cosmetic procedures, which are not reimbursable.
Even just considering payment for removal of skin tags, several ICD-10 codes are at play—some of which will be reimbursed under an insurance payment plan, some not. If you are a dermatologist who has payment denials for removal of skin tags, this is how I will walk you through the key ICD-10 codes so that you bill appropriately and you can get the most pay.
Understanding Skin Tags
Skin tags, or acrochordons, are benign, soft growths that usually appear on the body where rubbing exists, including the armpits, eyelids, neck, and groin. They are also known as soft fibromas, cutaneous papillomas, skin tabs, or fibroepithelial polyps.
Although usually harmless, skin tags get inflamed, red, or sore in some cases and need to be excised. Proper documentation of ICD-10 coding enables medical care providers to bill and document such procedures correctly for seamless claim process and reimbursement.
Why ICD-10 Codes for Skin Tag Removal Are Important
proper use of ICD-10 code for skin tags ensures:
- Accurate diagnosis and classification
- Efficient documentation
- Reimbursement justification when medically necessary removal
- Enhanced treatment planning and coordination
- Billable and non-billable removal distinction
Accurate coding not only optimizes billing processes but also enhances accurate diagnosis and facilitates simpler insurance approvals.
ICD-10 Codes for Skin Tag Removal: Billable or Non-Billable
It should be emphasized that one should distinguish reimbursable and non-reimbursable ICD-10 codes. There are the ones reimbursed by the insurance companies while others are non-reimbursable and cosmetic in intent and purpose and will necessitate out-of-pocket payment by the patient.
Billable ICD-10 Codes for Excision of Skin Tag
Some of the most commonly billable ICD-10 codes are the following:
L91.8 – Other Hypertrophic Disorders of the Skin
Use this code for any hypertrophic skin condition when no more specific code best defines the identified skin tag. As insurance companies value accuracy in coding highly, it is critical to document thoroughly about the skin tag’s site, characteristics, and symptoms.
D23.9 – Unspecified benign neoplasm of skin
This code is applied when a diagnosed skin tag has been identified as a benign neoplasm. It is a catch-all code and is only to be applied when no other more specific diagnosis has been made. It can be used to substantiate insurance reimbursement when applied with the proper procedural codes.
L98.8 – Other Specified Disorders of the Skin and Subcutaneous Tissue
This ICD-10 code is used when skin tags need to be removed due to other skin or subcutaneous tissue disease. Providers need to provide extensive documentation that supports the medical necessity for removal in order to be approved.
K64.4 – Posthemorrhoid residual skin tags
This is for residual skin tags of hemorrhoids that occur after hemorrhoid healing. Where removal is indicated due to discomfort or pain, use with the procedural codes will be reimbursed. This code should be avoided, however, for chronic hemorrhoids.
Non-Billable ICD-10 Codes for Removal of Skin Tags
The following codes are generally not paid for because they are for either unrelated skin tag conditions or cosmetic conditions.
L72.3 – Miliaria rubra (heat rash)
Miliaria Rubra, or prickly heat, also referred to as heat rash, consists of tiny, elevated bumps as a result of sweat gland blockage. Though they might appear like skin tags on the surface, they are an independent condition and cannot be included under skin tag removal procedures.
L91.0 – Hypertrophic Scar
Hypertrophic scars are thick, elevated scars from excess collagen during the healing process. Although commonly called skin tags, they are a distinct skin condition and are not reimbursable by skin tag removal codes.
L72.0 – Epidermal Cyst
Epidermal cysts are sacs of skin cells that are filled with keratin and may appear anywhere on the body. Because they are usually excised for cosmetic purposes, they do not qualify for reimbursement under skin tag excision codes.
Conclusion
In summary, skin tags are benign growths that typically arise in areas of skin that are rubbing against one another, including the neck, armpits, eyelids, and groin. Proper use of ICD-10 codes ensures accurate diagnosis, thorough documentation, and hassle-free reimbursement for medically necessary excisions.
This guideline set standard billable ICD-10 codes (L91.8, D23.9, L98.8, K64.4) and non-billable codes (L72.3, L91.0, L72.0) so that you would be able to differentiate between billable procedures under insurance and direct patient payment procedures.
If dermatology billing is a burden, outsourcing to a reputable professional billing firm such as XyberMed can automate claim submission and increase reimbursement rates.