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ICD-10 Guide
ICD-10 CodesD04.61

D04.61

Billable

Carcinoma in situ of skin of right upper limb, including shoulder

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

Code Description

ICD-10 D04.61 is a billable code used to indicate a diagnosis of carcinoma in situ of skin of right upper limb, including shoulder.

Key Diagnostic Point:

Carcinoma in situ (CIS) of the skin is a non-invasive form of skin cancer characterized by the abnormal growth of cells in the epidermis, the outermost layer of skin. In the case of D04.61, the carcinoma is specifically located on the right upper limb, including the shoulder. This condition is often detected through routine skin examinations or when patients present with suspicious lesions. CIS is considered an early stage of skin cancer, where the cancerous cells have not invaded deeper tissues or metastasized. The most common types of skin carcinoma in situ include squamous cell carcinoma in situ (SCCIS) and basal cell carcinoma in situ (BCCIS). Treatment options typically involve surgical excision, cryotherapy, or topical chemotherapy. Regular follow-up and surveillance are crucial to monitor for any signs of progression to invasive cancer, as well as to manage any new lesions that may arise. Patients with a history of skin cancer or significant sun exposure are at higher risk for developing additional skin cancers, necessitating ongoing dermatological assessments.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Specificity of location (right upper limb, including shoulder)
  • Differentiation between types of carcinoma in situ
  • Need for accurate documentation of clinical findings
  • Potential for multiple lesions requiring careful coding

Audit Risk Factors

  • Inadequate documentation of lesion characteristics
  • Failure to specify the exact location of the carcinoma
  • Misclassification of carcinoma type (e.g., SCCIS vs. BCCIS)
  • Lack of follow-up documentation post-treatment

Specialty Focus

Medical Specialties

Dermatology

Documentation Requirements

Detailed descriptions of lesions, treatment plans, and follow-up care.

Common Clinical Scenarios

Patients presenting with suspicious skin lesions, routine skin checks for high-risk patients.

Billing Considerations

Ensure accurate documentation of the size, location, and type of carcinoma in situ.

Oncology

Documentation Requirements

Comprehensive treatment plans, including surgical notes and pathology reports.

Common Clinical Scenarios

Management of patients with a history of skin cancer or those undergoing treatment for carcinoma in situ.

Billing Considerations

Coordination with dermatology for accurate staging and follow-up.

Coding Guidelines

Inclusion Criteria

Use D04.61 When
  • Follow the official ICD
  • CM guidelines for coding neoplasms, ensuring accurate documentation of the site and type of carcinoma
  • Include any relevant history of skin cancer and treatment details

Exclusion Criteria

Do NOT use D04.61 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 lesion.

Documentation Requirements

Pathology report confirming carcinoma in situ and excision details.

Specialty Considerations

Dermatology should document the size and margins of excised lesions.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of carcinoma in situ, improving the accuracy of data collection and treatment tracking. D04.61 provides detailed information about the location and type of carcinoma, which is essential for treatment planning and research.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of carcinoma in situ, improving the accuracy of data collection and treatment tracking. D04.61 provides detailed information about the location and type of carcinoma, which is essential for treatment planning and research.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of carcinoma in situ, improving the accuracy of data collection and treatment tracking. D04.61 provides detailed information about the location and type of carcinoma, which is essential for treatment planning and research.

Resources

Clinical References

  • •
    American Academy of Dermatology

Coding & Billing References

  • •
    American Academy of Dermatology

Frequently Asked Questions

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

Carcinoma in situ is a non-invasive form of cancer where abnormal cells are confined to the epidermis, while invasive carcinoma has penetrated deeper into surrounding tissues.