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.

Check D48.5 with the rest of the claim: free scrubber

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

Excludes1 inherited from the categories above D48.5

A category’s note binds every code beneath it.

Written on D48: Neoplasm of uncertain behavior of other and unspecified sites

neurofibromatosis (nonmalignant) (Q85.0-)

Other codes that can never be billed with D48.5

Their own Excludes1 notes name this code, so the conflict is not listed above.

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
D37.0Neoplasm of uncertain behavior of lip, oral cavity and pharynx

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

D48.5 is named in 39 Medicare coverage policies: 39 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

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