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).

What cannot be coded together with D04.0?

D04.0 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above D04.0 (D04) and apply to it just the same.

D04.0

D04.0 — Carcinoma in situ of skin of lip

Billable / specific codeICD-10-CM

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)

Excludes1 inherited from the categories above D04.0

These are not written on D04.0, but they bind it: a note on a category applies to every code beneath it. Billing D04.0 with anything listed here is a denial.

Written on D04 — Carcinoma in situ of skin

erythroplasia of Queyrat (penis) NOS (D07.4)
melanoma in situ (D03.-)

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

Code history

D04.0 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share D04. If D04.0 is not quite right, the correct code is usually one of these.

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).
What cannot be coded together with D04.0?: D04.0 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above D04.0 (D04) and apply to it just the same.