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ICD-10 Guide
ICD-10 CodesD04.6

D04.6

Billable

Carcinoma in situ of skin of upper limb, including shoulder

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

Code Description

ICD-10 D04.6 is a billable code used to indicate a diagnosis of carcinoma in situ of skin of upper limb, including shoulder.

Key Diagnostic Point:

Carcinoma in situ of the skin of the upper limb, including the shoulder, refers to a localized form of skin cancer where abnormal cells are present in the outer layer of the skin (epidermis) but have not invaded deeper tissues. This condition is often characterized by the presence of atypical keratinocytes, which can arise from various skin lesions, including actinic keratosis or squamous cell carcinoma. Patients may present with lesions that appear as scaly patches, non-healing sores, or elevated growths. The risk factors for developing carcinoma in situ include prolonged sun exposure, fair skin, and a history of skin cancer. Early detection and treatment are crucial to prevent progression to invasive cancer. Treatment options may include surgical excision, cryotherapy, or topical chemotherapy. Regular follow-up and skin examinations are essential for monitoring potential recurrence or new lesions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between various types of skin lesions
  • Understanding the nuances of carcinoma in situ versus invasive carcinoma
  • Documentation of lesion characteristics and treatment plans
  • Knowledge of surveillance protocols and follow-up care

Audit Risk Factors

  • Inadequate documentation of lesion size and characteristics
  • Failure to document follow-up care and surveillance
  • Misclassification of the lesion type
  • Inconsistent coding of treatment modalities

Specialty Focus

Medical Specialties

Dermatology

Documentation Requirements

Detailed descriptions of the lesion, including size, location, and histological findings.

Common Clinical Scenarios

Diagnosis and treatment of skin lesions, follow-up for skin cancer surveillance.

Billing Considerations

Ensure accurate coding based on biopsy results and treatment plans.

Oncology

Documentation Requirements

Comprehensive treatment plans, including surgical notes and follow-up care.

Common Clinical Scenarios

Management of skin cancer patients, including chemotherapy and radiation therapy.

Billing Considerations

Coordination of care with dermatology for comprehensive patient management.

Coding Guidelines

Inclusion Criteria

Use D04.6 When
  • According to ICD
  • 10 coding guidelines, D04
  • 6 should be used when the carcinoma in situ is confirmed by biopsy
  • It is essential to document the specific location and characteristics of the lesion

Exclusion Criteria

Do NOT use D04.6 When
  • Exclusions include invasive carcinoma and benign skin lesions

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 diagnosis and details of the procedure.

Specialty Considerations

Dermatology and oncology must ensure accurate coding based on biopsy results.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of skin conditions, including carcinoma in situ, enhancing the ability to track and manage these cases effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of skin conditions, including carcinoma in situ, enhancing the ability to track and manage these cases effectively.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of skin conditions, including carcinoma in situ, enhancing the ability to track and manage these cases effectively.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between carcinoma in situ and invasive carcinoma?

Carcinoma in situ refers to cancer cells that are localized and have not invaded surrounding tissues, while invasive carcinoma has spread beyond the original site into deeper layers of skin or other tissues.