Squamous cell carcinoma (SCC) is a most common type of skin cancer. The cancer begins in the sqamous cells, the tissue the forms the surface of the cells. This usually occur on the body areas exposed to sunlight including the rim of the ear, lower lip, bald scalp, face, neck, hands, arms and legs. Though ICD-9 has codes to report this condition, the new ICD-10 coding system provides more specific codes. The details in coding below has been put together for review by Dermatology Oncology practices or medical coding companies who deal with the specialty.
SCC – Causes, Signs and Symptoms, Treatment
Though SCC is commonly found in fair-skinned people who are exposed to sunlight or other ultraviolet radiation for a long time, there are several other risk factors such as blue or green eyes or blond or red hair, long-term daily sun exposure without sun protection or covering up, severe sunburns that may have occurred earlier, old age, long-term exposure or overexposure to X-rays, chemical exposures and tanning bed use. The signs and symptoms of this disease include:
- Growing bump that may have a rough, scaly surface and flat reddish patches
- Lump on the skin or under the nail
- Dome-shaped or crusty lesion that may bleed
- Having a sore that doesn’t heal
Any change in an existing wart, mole, or other skin lesion should be noted, as it could be a sign of SCC.
When it comes to examination and tests, the patient’s skin is checked while focusing on the size, shape, color and texture of any suspicious areas. A skin biopsy can be done to confirm SCC in which a piece of skin will be removed and sent to the laboratory for examination under a microscope. There are several treatments available for SCC such as excision, cryosurgery, Mohs surgery, photodynamic therapy, curettage and electrodessication, radiation and medication. However, the treatment will depend upon the size and location of the skin cancer, how far it has spread and the patient’s health condition.
ICD-10 Coding and Documentation
In ICD-9, the codes for SCC come under ‘Other and unspecified malignant neoplasm of skin’ (173) and it specifies just the body area where the cancer occurs. For example, 173.22:Squamous cell carcinoma of the skin of the ear and external auditory canal. However, ICD-10 codes specify the exact site on the skin along with the laterality (right or left). Here are the codes:
- C44.02:Squamous cell carcinoma of skin of lip
- C44.12: Squamous cell carcinoma of skin of eyelid, including canthus
- C44.121: Squamous cell carcinoma of skin of unspecified eyelid, including canthus
- C44.122: Squamous cell carcinoma of skin of right eyelid, including canthus
- C44.129: Squamous cell carcinoma of skin of left eyelid, including canthus
- C44.22: Squamous cell carcinoma of skin of ear and external auricular canal
- C44.221: Squamous cell carcinoma of skin of unspecified ear and external auricular canal
- C44.222: Squamous cell carcinoma of skin of right ear and external auricular canal
- C44.229: Squamous cell carcinoma of skin of left ear and external auricular canal
- C44.32: Squamous cell carcinoma of skin of other and unspecified parts of face
- C44.320: Squamous cell carcinoma of skin of unspecified parts of face
- C44.321: Squamous cell carcinoma of skin of nose
- C44.329: Squamous cell carcinoma of skin of other parts of face
- C44.42:Squamous cell carcinoma of skin of scalp and neck
- C44.52: Squamous cell carcinoma of skin of trunk
- C44.520: Squamous cell carcinoma of anal skin
- C44.521: Squamous cell carcinoma of skin of breast
- C44.529: Squamous cell carcinoma of skin of other part of trunk
- C44.62: Squamous cell carcinoma of skin of upper limb, including shoulder
- C44.621: Squamous cell carcinoma of skin of unspecified upper limb, including shoulder
- C44.622: Squamous cell carcinoma of skin of right upper limb, including shoulder
- C44.629: Squamous cell carcinoma of skin of left upper limb, including shoulder
- C44.72: Squamous cell carcinoma of skin of lower limb, including hip
- C44.721: Squamous cell carcinoma of skin of unspecified lower limb, including hip
- C44.722: Squamous cell carcinoma of skin of right lower limb, including hip
- C44.729: Squamous cell carcinoma of skin of left lower limb, including hip
- C44.82: Squamous cell carcinoma of overlapping sites of skin
- C44.92: Squamous cell carcinoma of skin, unspecified
For the proper assignment of ICD-10 code for squamous cell carcinoma, you should include the following in your clinical documentation:
- Specify whether the site is primary, secondary or carcinoma in situ. However, when the term SCC or squamous cell carcinoma is used without further definition, it is understood to be a primary site
- Exact site of the skin where SCC occurred
- Laterality
- Personal or family history of skin cancer, if any or current or history of smoking/smoking exposure
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