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ICD-10 Guide
ICD-10 CodesD04.3

D04.3

Billable

Carcinoma in situ of skin of other and unspecified parts of face

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

Code Description

ICD-10 D04.3 is a billable code used to indicate a diagnosis of carcinoma in situ of skin of other and unspecified parts of face.

Key Diagnostic Point:

Carcinoma in situ (CIS) of the skin represents a localized, non-invasive form of skin cancer where abnormal cells are present but have not invaded deeper tissues. Specifically, D04.3 refers to CIS located in other and unspecified parts of the face, which may include areas such as the forehead, cheeks, or around the eyes and mouth. This condition is characterized by the presence of atypical keratinocytes confined to the epidermis, and it is often detected through skin examinations or biopsies. Risk factors for developing CIS include prolonged sun exposure, fair skin, and a history of skin cancer. Surveillance protocols typically involve regular dermatological evaluations to monitor for changes in the lesion, as well as patient education on sun protection and skin self-examinations. The risk of progression to invasive carcinoma is present, particularly if left untreated, making early detection and intervention critical.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in documentation of lesion location
  • Differentiation from other skin lesions
  • Need for precise clinical descriptions
  • Potential for misclassification with invasive cancers

Audit Risk Factors

  • Inadequate documentation of lesion characteristics
  • Failure to specify the exact location of the lesion
  • Inconsistent terminology used in clinical notes
  • Lack of follow-up documentation

Specialty Focus

Medical Specialties

Dermatology

Documentation Requirements

Detailed descriptions of the lesion, including size, location, and characteristics.

Common Clinical Scenarios

Diagnosis of CIS during routine skin checks, biopsy results indicating CIS.

Billing Considerations

Ensure that all findings are clearly documented to support the diagnosis and coding.

Oncology

Documentation Requirements

Comprehensive treatment plans and follow-up notes.

Common Clinical Scenarios

Management of CIS with topical therapies or surgical excision.

Billing Considerations

Documenting the rationale for treatment choices and monitoring for progression.

Coding Guidelines

Inclusion Criteria

Use D04.3 When
  • According to ICD
  • CM guidelines, D04
  • 3 should be used when the carcinoma in situ is confirmed by biopsy and is specifically located in other and unspecified parts of the face
  • Coders must ensure that the diagnosis is supported by clinical documentation and that the lesion's characteristics are clearly described

Exclusion Criteria

Do NOT use D04.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

11100CPT Code

Biopsy of skin, excisional

Clinical Scenario

Used when a biopsy is performed to confirm carcinoma in situ.

Documentation Requirements

Pathology report confirming carcinoma in situ must be included.

Specialty Considerations

Dermatologists should ensure that the biopsy site is clearly documented.

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. D04.3 provides a clear designation for non-invasive skin cancers, improving data accuracy and treatment tracking.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding skin conditions, including carcinoma in situ. D04.3 provides a clear designation for non-invasive skin cancers, improving data accuracy and treatment tracking.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding skin conditions, including carcinoma in situ. D04.3 provides a clear designation for non-invasive skin cancers, improving data accuracy and treatment tracking.

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 critical diagnosis as it indicates the presence of abnormal cells that have not invaded surrounding tissues. Early detection and treatment are essential to prevent progression to invasive cancer.