D04.0 — Carcinoma in situ of skin of lip
D04.0 is a billable, specific ICD-10-CM code for carcinoma in situ of skin of lip. It is valid for submission on a claim.
Excludes2 — not included here, but may coexist
The excluded condition is not part of this code, but a patient can have both. You may code both.
- carcinoma in situ of vermilion border of lip (D00.01)
Other codes that can never be billed with D04.0
These codes carry an Excludes1 note pointing at D04.0. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading D04.0 alone.
- D00.0Carcinoma in situ of lip, oral cavity and pharynx
Risk adjustment
D04.0 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
D04.0 is named in 36 Medicare coverage policies — 36 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52480Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article
- A53883Billing and Coding: Mohs Micrographic Surgery (MMS)
- A54768Billing and Coding: Cardiac Blood Pool Imaging (Multiple Gated Acquisition Scanning- MUGA, Ventriculography) When Performed in Conjunction with Cardiotoxic Chemotherapy
- A56346Billing and Coding: Removal of Benign and Malignant Skin Lesions
Related codes at this level
Codes that share D04. If D04.0 is not quite right, the correct code is usually one of these.
- D04.1Carcinoma in situ of skin of eyelid, including canthus
- D04.2Carcinoma in situ of skin of ear and external auricular canal
- D04.3Carcinoma in situ of skin of other and unspecified parts of face
- D04.4Carcinoma in situ of skin of scalp and neck
- D04.5Carcinoma in situ of skin of trunk
- D04.6Carcinoma in situ of skin of upper limb, including shoulder
- D04.7Carcinoma in situ of skin of lower limb, including hip
- D04.8Carcinoma in situ of skin of other sites
- D04.9Carcinoma in situ of skin, unspecified
Questions about D04.0
- Is D04.0 a billable ICD-10-CM code?
- Yes. D04.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does D04.0 sit in the tabular list?
- Neoplasms (C00-D49), in the block In situ neoplasms (D00-D09).