Skin tags are benign, soft, and often small growths of skin that hang off the body. They are commonly found in areas where skin rubs against skin, such as the neck, armpits, under the breasts, and groin.
Other Common Names for Skin Tags:
- Acrochordons
- Fibroepithelial polyps
- Soft fibromas
- Cutaneous papillomas
- Skin tabs
Although skin tags are harmless, they can sometimes cause irritation, especially if they rub against clothing or jewelry. When it comes to medical billing, understanding the correct ICD-10 codes for skin tags is crucial for healthcare providers and billing professionals.
In this blog, we will break down the ICD-10 codes related to skin tags, including both billable and non-billable codes, along with examples and guidance on how to use them.
How to Properly Code ICD-10 for Skin Tags
In the ICD-10 coding system, skin tags are classified under the code L91.8, which refers to “Other hypertrophic skin conditions.” However, depending on the location and nature of the skin tag, there are several codes that might be applicable. Some of these codes are billable (i.e., can be used for reimbursement) while others are non-billable.
Accurately coding skin tags in ICD-10 can be challenging due to the variety of codes and similarities between different skin conditions. To ensure correct coding and reimbursement, healthcare providers and coding professionals should focus on:
- Identifying the appropriate ICD-10 codes for skin tags
- Ensuring proper documentation to establish medical necessity
- Applying modifiers correctly when required
- Following AAPC (American Academy of Professional Coders) compliance guidelines
In-house coding teams may struggle with these complexities, leading to claim denials and revenue loss. Outsourcing medical billing services to specialized professionals can help avoid errors and improve reimbursement rates.
Key Factors in Billing for Skin Tag Removal
Accurate billing for skin tag removal depends on proper documentation and coding. Coverage varies based on whether the procedure is deemed medically necessary or cosmetic, as insurance companies have different policies regarding reimbursement.
- Medical Necessity vs. Cosmetic Removal
Insurance coverage largely depends on the reason for removal:
- Cosmetic Removal: If a patient requests removal purely for aesthetic reasons, insurance does not cover the procedure. The patient must pay the full cost.
- Medically Necessary Removal: If skin tags cause discomfort, irritation, bleeding, or interfere with daily activities, insurance may cover the procedure. Proper documentation of symptoms is required.
- Impact of Lesion Count on Billing
The number of skin tags removed affects coding:
- Removal of up to 15 skin tags is billed using CPT 11200.
- Each additional 10 skin tags requires CPT 11201.
Proper coding ensures reimbursement aligns with the number of lesions treated.
- Anesthesia Considerations
If anesthesia is needed, it should be coded separately using appropriate CPT codes. The type of anesthesia (local, regional, or general) and the provider administering it determine the correct coding.
Example:
- Local anesthesia for minor removals is typically included in the procedure code.
- General or monitored anesthesia care requires separate billing.
Skin Tag ICD-10 Codes List
| Skin Tag Location/Condition | ICD-10 Code | Reason/Explanation | Billable/Unbillable |
| Neck | L91.8 | Skin tags in the neck area fall under hypertrophic skin disorders. | Billable |
| Irritated | L91.8 | Irritated skin tags are categorized as “Other hypertrophic disorders of the skin.” | Billable |
| Inflamed | L98.8 | Inflamed skin tags are classified under “Other specified skin disorders.” | Billable |
| Eyelid | D23.9 | Inflamed skin tags are classified under “Other specified skin disorders.” | Billable |
| Face | D23.9 | Facial skin tags are also classified as benign neoplasms of the skin. | Billable |
| Left Axilla | L91.8 | Hypertrophic disorders like skin tags may appear in the axilla area. | Billable |
| Bleeding | L98.8 | Bleeding skin tags are included under “Other specified skin conditions.” | Billable |
| Rectal | K64.4 | Residual skin tags found in the rectal area are associated with previous hemorrhoid treatment. | Billable |
| Genital | L98.8 | Genital skin tags are categorized under “Other specified disorders of the skin.” | Billable |
| Unspecified | D23.9 | Unspecified benign neoplasms of the skin, including skin tags in general. | Billable |
| Labial | L98.8 | Skin tags on the labia are covered under “Other specified skin disorders.” | Billable |
| Groin | L91.8 | Skin tags in the groin area are classified under hypertrophic skin conditions. | Billable |
| Back | D23.9 | Benign skin neoplasms, including skin tags, can be found on the back. | Billable |
| Perianal | K64.4 | Skin tags around the perianal area are considered residual hemorrhoidal skin tags. | Billable |
| Ear | D23.9 | Skin tags located on the ear fall under benign neoplasms of skin | Billable |
| Anus | K64.4 | Residual hemorrhoidal skin tags commonly occur around the anus. | Billable |
Billable ICD-10 Codes for Skin Tags
When coding for skin tags, healthcare providers can use several ICD-10 codes based on the specific diagnosis. Below are the applicable billable codes:
L91.8 – Other hypertrophic skin conditions (skin tag)
ICD-10 code L91.8 is assigned to “Other hypertrophic disorders of the skin.” This code is used when a more precise classification is unavailable and includes conditions with abnormal skin overgrowth, such as skin tags.
Example:
- Patient: John Doe, a 45-year-old male with a small skin tag on his neck, presents to the clinic for removal.
- Diagnosis Code: L91.8 (Other hypertrophic skin conditions)
Since L91.8 is a broad classification, it is recommended to use a more specific code when possible. However, when no detailed diagnosis is available, this code serves as a general option for documenting and billing encounters related to skin tags.
For accurate billing, medical records should include a clear description of the skin tags, their location, and any associated symptoms. Detailed documentation not only supports the chosen ICD-10 code but also ensures proper communication among healthcare providers involved in patient care.
| Note: When coding for skin tags, ensure that the skin tag is benign and not associated with other conditions like neoplasms (cancerous growths). |
L98.8 – Other Specified Disorders of the Skin and Subcutaneous Tissue
For skin tags that do not fit under a more specific classification, L98.8 is used. This code is applied when documenting and billing for skin tag removal, but it also includes a variety of other skin and subcutaneous tissue conditions.
Since L98.8 covers multiple disorders, medical coders must ensure proper documentation to justify its use for skin tag cases. Additionally, when submitting claims for skin tag removal under this code, healthcare providers should also include the appropriate CPT code for the specific procedure performed. Using both ICD-10 and CPT codes correctly ensures accurate billing and reimbursement.
Example:
Patient: Sarah Thompson, a 40-year-old female, presents with multiple small skin tags on her back. The skin tags are not located in typical areas and do not fit under more specific classifications like those for the face or neck.
- Diagnosis Code: L98.8 (Other specified disorders of the skin and subcutaneous tissue)
- Procedure: Removal of multiple skin tags from the back.
- CPT Code: 11200 (Removal of skin tags, multiple lesions)
| Note: As this patient’s skin tags do not fall under a more specific ICD-10 classification (such as L82.0 or L82.1), the code L98.8 is used. The removal procedure is documented with the appropriate CPT code for skin tag removal. Correct use of both ICD-10 and CPT codes is essential for accurate billing and reimbursement. |
D23.9 – Benign Neoplasm of Skin, Unspecified
D23.9 is another ICD-10 code applicable to skin tags, covering any benign skin growths, including these small, noncancerous lesions. If a patient presents with a skin tag, this code can be used for diagnosis. Additionally, if removal is performed, the procedure and diagnosis can both be billed under D23.9.
Steps for billing with D23.9:
- Diagnose the skin tag using D23.9.
- Bill the diagnostic examination under D23.9.
- If removal is performed, complete the procedure.
- Submit billing for the removal procedure using D23.9.
- This code falls under the D22-D23 category, which covers benign skin tumors. By using D23.9, payers can identify the diagnosis and treatment of a noncancerous skin growth.
K64.4 – Residual Hemorrhoidal Skin Tags
Some skin tags develop as a result of treated or resolved hemorrhoids. These leftover skin growths, known as residual hemorrhoidal skin tags, are not the hemorrhoids themselves but rather excess skin that remains after the healing process. These tags may cause discomfort, irritation, or require removal.
ICD-10 code K64.4 is specifically designated for residual hemorrhoidal skin tags. This code is used for billing when a provider diagnoses and manages this condition.
If a patient has persistent skin tags following hemorrhoid treatment, K64.4 should be used. However, this code should not be applied to cases involving active hemorrhoids or other rectal conditions.
To ensure accurate coding and billing, medical records should explicitly describe the presence of residual hemorrhoidal skin tags, including the patient’s medical history, physical exam findings, and any procedures performed.
Example:
Patient: Michael Harris, a 52-year-old male, presents with residual skin tags around the anal area following previous treatment for hemorrhoids. The patient reports mild irritation and occasional discomfort during daily activities but no current signs of active hemorrhoids.
- Diagnosis Code: K64.4 (Residual hemorrhoidal skin tags)
- Procedure: Removal of residual hemorrhoidal skin tags.
- CPT Code: 46221 (Excision of hemorrhoids, multiple)
| Note: The patient’s skin tags are a result of previous hemorrhoidal treatment, not active hemorrhoids. As such, K64.4 is used to accurately document and bill for the residual hemorrhoidal skin tags. The procedure for removal is captured with the correct CPT code. Proper documentation, including medical history, physical exam findings, and procedure details, ensures accurate coding and billing. |
Non-Billable ICD-10 Codes for Skin Tags
While some ICD-10 codes justify medical necessity for skin tag removal, others indicate cases where removal is not considered essential for health. These non-billable codes apply when skin tags are asymptomatic and do not cause medical issues.
In most cases, if skin tags are removed solely for cosmetic purposes, insurance will not cover the procedure. Providers can inform patients about cosmetic treatment options, but these are typically paid out-of-pocket. Submitting non-billable codes for reimbursement is likely to result in claim denials.
L72.0 — Epidermal Cyst
The ICD-10 code L72.0 applies to epidermal cysts, which are keratin-filled sacs covered by a layer of skin cells. In some cases, these cysts may be confused with skin tags, leading to documentation under this code. However, epidermal cysts are a separate condition and can develop anywhere on the body.
Although L72.0 can be useful for record-keeping, it does not justify skin tag removal for insurance billing. Since skin tags are classified as benign growths without medical risk, they are generally viewed as a cosmetic concern rather than a medical necessity.
Example:
Patient: Emily Johnson, a 34-year-old female, presents with a small, round bump on her forearm. The bump is firm, slightly tender to touch, and has a smooth surface. After a thorough examination, the provider diagnoses the bump as an epidermal cyst rather than a skin tag.
- Diagnosis Code: L72.0 (Epidermal cyst)
- Procedure: Drainage of the epidermal cyst.
| Note: Although the cyst may appear similar to a skin tag, it is a keratin-filled sac and is not classified as a skin tag. The provider documents the condition as an epidermal cyst using the appropriate ICD-10 code L72.0. Since this condition is not a skin tag, it is not billed for cosmetic removal. |
L72.3 — Miliaria Rubra
ICD-10 code L72.3 refers to miliaria rubra, commonly known as “prickly heat” or “heat rash.” Though the small, raised bumps associated with this condition may resemble skin tags, they are unrelated. Miliaria rubra occurs when sweat glands become blocked, trapping perspiration beneath the skin. It often develops in hot, humid conditions or due to excessive sweating.
This code is intended for documenting and billing cases of heat rash, not skin tags. Since miliaria rubra and skin tags are distinct conditions, L72.3 does not apply to skin tag diagnosis or removal.
L91.0 — Hypertrophic Scar
ICD-10 code L91.0 is assigned to hypertrophic scars, which form as thick, raised areas of skin following injuries, burns, surgeries, or inflammation. These scars develop due to excess collagen production during the healing process.
While hypertrophic scars may sometimes be mistaken for skin tags, they are structurally different. Skin tags are soft, small, and attached by a narrow stalk, whereas hypertrophic scars are dense and localized to the injury site. Since L91.0 is designated for scars rather than skin tags, it does not support medical necessity for skin tag removal and is not a billable code.
Example:
Patient: Sarah Thompson, a 40-year-old female, presents with a thick, raised scar on her forearm following a surgical procedure six months ago. The scar is firm, red, and localized to the injury site.
- Diagnosis Code: L91.0 (Hypertrophic Scar)
- Procedure: Scar management, including topical treatments and possible steroid injections.
| Note: Although hypertrophic scars can sometimes be confused with skin tags, they are structurally different. Skin tags are soft and attached by a narrow stalk, while hypertrophic scars are dense and remain at the site of injury. Since L91.0 applies only to hypertrophic scars, it does not support medical necessity for skin tag removal and is not a billable code for that procedure. |
Comparison of Billable vs. Non-Billable ICD-10 Codes for Skin Tags
| Category | Billable ICD-10 Codes | Non-Billable ICD-10 Codes |
| Codes | L91.8 – Other hypertrophic disorders of the skin | L72.3 – Miliaria Rubra |
| D23.9 – Other benign neoplasm of skin, unspecified | L91.0 – Hypertrophic Scar | |
| Condition | Used for skin tags when medical necessity is proven | Codes conditions that resemble but are not skin tags |
| Medical Necessity | Covered if skin tags cause pain, bleeding, or irritation | Not covered if removal is for cosmetic purposes |
| Insurance Coverage | May be reimbursed with proper documentation | Claims using these codes for skin tags will likely be denied |
| Alternative Codes | L98.8 – Other specified disorders of the skin | L72.0 – Epidermal Cyst |
| Use in Claims | Used when removal is justified for medical reasons | Should not be used for skin tag coding |
| Examples | Skin tags that are inflamed or frequently irritated | K64.4 – Residual hemorrhoidal skin tags (different from typical skin tags) |
Modifiers Used for Skin Tag Removal in Medical Coding
Modifiers are essential in medical coding as they provide additional details about a procedure, ensuring proper billing and reimbursement. When coding for skin tag removal, common modifiers used include:
Modifier 59 – Distinct Procedural Service
This modifier is used when multiple procedures are performed on the same day but at different sites or for distinct reasons.
Example: A patient has multiple skin tags removed—one from the neck and another from the groin. The coder would use Modifier 59 to indicate that these are separate procedures.
- CPT Code: 11200 (Removal of skin tags, up to 15 lesions)
- CPT Code: 11200-59 (For the second distinct site)
Modifier 25 – Significant, Separately Identifiable Evaluation and Management (E/M) Service
Used when a physician performs an E/M service in addition to skin tag removal during the same visit.
Example: A patient visits for a routine check-up and also requests skin tag removal. Since the check-up is a separate service, Modifier 25 is added to the E/M code.
- E/M Code: 99213 (Office visit)
Modifier 76 – Repeat Procedure by the Same Physician
Applied when a provider performs the same skin tag removal procedure on a different date for the same patient.
Example: A patient returns two weeks later for additional skin tag removal. Since the same provider is performing the same procedure, Modifier 76 is added.
- CPT Code: 11200-76 (Repeat skin tag removal procedure)
Modifier 77 – Repeat Procedure by Another Physician
Used when another provider performs the same skin tag removal procedure at a different time.
Example: A patient initially had a skin tag removed by one dermatologist but later sees another provider for additional removals. Modifier 77 is used to indicate the different provider.
CPT Code: 11200-77 (Repeat skin tag removal by another physician)
Modifier 22 – For Prolonged Services
This modifier applies when skin tag removal is more complex due to factors like:
- Excessive bleeding requiring additional control
- Multiple large skin tags that need extensive removal
- Unusual anatomical location (e.g., eyelids, anal region) making the procedure more difficult
- Patient-specific complications (e.g., thickened or inflamed skin) requiring extra work
Example:
A patient has multiple large and inflamed skin tags on the neck and underarms, making removal more difficult. The provider spends significantly more time controlling bleeding and ensuring proper excision.
- CPT Code: 11200-22 (Removal of up to 15 skin tags, increased complexity)
The Bottom Line
Correctly coding for skin tags is important for accurate medical billing and insurance reimbursement. Always remember to verify whether the skin tag is benign and document the patient’s medical history appropriately to avoid errors in coding. Most importantly, your coding team must be well-versed in the latest coding guidelines.
| Note: The names of the patients used in the blog are hypothetical as per HIPAA-compliance. |
References
https://www.aafp.org/pubs/fpm/issues/2005/1000/p47.html
https://www.icd10data.com/ICD10CM/Codes/L00-L99/L80-L99/L91-/L91.8 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57044&keyword=D84.81&areaId=all&docType=NCA
