Primary Care Coding Alert

Question: Our physicians sometimes see patients who don't personally have malignant melanoma but have family history that puts them at a high-risk level. What is the ICD-9 code for it?

Wisconsin Subscriber

Answer: The family history of melanoma falls under the code V16.8 (Family history of malignant neoplasm; other specified malignant neoplasm), which may not be a covered primary diagnosis.

Protect yourself: Don't opt for V16.8 as primary on the claim form. Instead, use the diagnosis(es) for the skin lesions that the family physician reviewed upon examination (i.e., nevi and seborrheic keratosis), even if the lesions do not require treatment. It is still considered a medical decision when your family physician examined the lesion and decided no treatment was needed. Not to mention that you would need these diagnoses to support the patient's E/M visit.

Meanwhile, most carriers accept the other V codes V10.82 (Personal history of malignant neoplasm of other sites; malignant melanoma of skin) and V10.83 (Personal history of malignant neoplasm; other malignant neoplasm of skin) as primary diagnoses.