Is D48.5 a billable ICD-10-CM code?

Yes. D48.5 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does D48.5 sit in the tabular list?

Neoplasms (C00-D49), in the block Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (D37-D48).

What cannot be coded together with D48.5?

D48.5 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

D48.5

D48.5 — Neoplasm of uncertain behavior of skin

Billable / specific codeICD-10-CM

D48.5 is a billable, specific ICD-10-CM code for neoplasm of uncertain behavior of skin. It is valid for submission on a claim.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

neoplasm of uncertain behavior of anus NOS (D37.8)
neoplasm of uncertain behavior of skin of genital organs (D39.8, D40.8)
neoplasm of uncertain behavior of vermilion border of lip (D37.0)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Neoplasm of uncertain behavior of anal margin
Neoplasm of uncertain behavior of anal skin
Neoplasm of uncertain behavior of perianal skin
Neoplasm of uncertain behavior of skin of breast

Other codes that can never be billed with D48.5

These codes carry an Excludes1 note pointing at D48.5. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading D48.5 alone.

D37.0Neoplasm of uncertain behavior of lip, oral cavity and pharynx
D37.8Neoplasm of uncertain behavior of other specified digestive organs
D38.5Neoplasm of uncertain behavior of other respiratory organs
D48.6Neoplasm of uncertain behavior of breast
D48.7Neoplasm of uncertain behavior of other specified sites

Risk adjustment

D48.5 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

D48.5 is named in 50 Medicare coverage policies — 50 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
A53101Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID® Update
A53883Billing and Coding: Mohs Micrographic Surgery (MMS)
A54188Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID®

How D48.5 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to D48.5.

Nevus›bathing trunk
Tumor›basal cell
Nevus›pigmented›giant

Related codes at this level

Codes that share D48. If D48.5 is not quite right, the correct code is usually one of these.

Questions about D48.5

Is D48.5 a billable ICD-10-CM code?: Yes. D48.5 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does D48.5 sit in the tabular list?: Neoplasms (C00-D49), in the block Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (D37-D48).
What cannot be coded together with D48.5?: D48.5 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.