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ICD-10 Guide
ICD-10 CodesD04.111

D04.111

Billable

Carcinoma in situ of skin of right upper eyelid, including canthus

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 D04.111 is a billable code used to indicate a diagnosis of carcinoma in situ of skin of right upper eyelid, including canthus.

Key Diagnostic Point:

Carcinoma in situ (CIS) of the skin is a non-invasive form of cancer that is confined to the epidermis, the outermost layer of skin. In the case of D04.111, the carcinoma is specifically located on the right upper eyelid, including the canthus, which is the corner of the eye where the upper and lower eyelids meet. This condition is characterized by abnormal growth of skin cells that have not yet invaded deeper tissues. While CIS is not life-threatening, it has the potential to progress to invasive cancer if left untreated. Regular surveillance and monitoring are crucial, especially for patients with a history of skin cancers or significant sun exposure. Treatment options may include surgical excision, cryotherapy, or topical chemotherapy, depending on the size and characteristics of the lesion. The prognosis is generally favorable with appropriate management, but vigilance is necessary to prevent recurrence or progression.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Specificity of the anatomical location (right upper eyelid, including canthus)
  • Need for accurate documentation of the carcinoma in situ status
  • Potential for misclassification with invasive skin cancers
  • Variability in treatment protocols based on lesion characteristics

Audit Risk Factors

  • Inadequate documentation of the carcinoma in situ diagnosis
  • Failure to document the specific location of the lesion
  • Misuse of codes for invasive skin cancers
  • Lack of follow-up documentation for surveillance

Specialty Focus

Medical Specialties

Dermatology

Documentation Requirements

Detailed clinical notes describing the lesion, treatment plan, and follow-up care.

Common Clinical Scenarios

Diagnosis and treatment of skin lesions, including biopsies and excisions.

Billing Considerations

Ensure accurate documentation of the lesion's characteristics and location to avoid misclassification.

Ophthalmology

Documentation Requirements

Comprehensive eye examination notes, including visual acuity and any ocular symptoms.

Common Clinical Scenarios

Management of eyelid lesions, including surgical interventions and cosmetic considerations.

Billing Considerations

Document any impact on vision or eyelid function due to the carcinoma.

Coding Guidelines

Inclusion Criteria

Use D04.111 When
  • According to ICD
  • 10 coding guidelines, D04
  • 111 should be used when the carcinoma is confirmed as in situ and specifically located on the right upper eyelid
  • Coders must ensure that the diagnosis is supported by pathology reports and clinical documentation

Exclusion Criteria

Do NOT use D04.111 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

11400CPT Code

Excision, benign lesion

Clinical Scenario

Used when excising a carcinoma in situ from the eyelid.

Documentation Requirements

Pathology report confirming carcinoma in situ and operative notes detailing the excision.

Specialty Considerations

Dermatology and ophthalmology must coordinate on the excision approach.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding skin conditions, including carcinoma in situ. D04.111 provides a clear distinction from invasive cancers, which is crucial for treatment planning and insurance reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding skin conditions, including carcinoma in situ. D04.111 provides a clear distinction from invasive cancers, which is crucial for treatment planning and insurance reimbursement.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    American Academy of Dermatology

Coding & Billing References

  • •
    American Academy of Dermatology

Frequently Asked Questions

What is the significance of carcinoma in situ?

Carcinoma in situ is a non-invasive cancer that has not spread beyond the epidermis. It is crucial to identify and treat it early to prevent progression to invasive cancer.