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Medical Policy: 02.01.07
Original Effective Date: February 1999
Reviewed: April 2008
Revised: December 2003
This policy applies to all products unless specific contract
limitations, exclusions or exceptions apply. Please refer to the member's coverage
manual for benefit availability. Managed care guidelines related to referral authorization,
and precertification of inpatient hospitalization, home health, home infusion and
hospice services apply.
Description:
Digital mole mapping, also know as epiluminescence microscopy (ELM), dermoscopy or dermatoscopy is a technology for in vivo imaging and inspection of skin lesions which offers the physician the ability to have a baseline image to refer to so he or she can examine each suspicious lesion, and then compare them year after year, by re-imaging. Dermatoscopic images may be assessed by direct visual examination, or by review of standard or digitized photographs. Digitization of images, either surface or dermatoscopic images, may permit qualitative image enhancement for better visual perception and discrimination of certain features, or actual computer-assisted diagnosis.
Policy:
Digital mole mapping/Dermatoscopy using either direct inspection, digitization of images, or computer-assisted analysis, is considered investigational as a technique to evaluate or serially monitor pigmented skin lesions. This is because it allows physicians to monitor a mole growth rather than immediately excising a potentially malignant lesion, and performing histological analysis, which is considered the gold standard of care. Delay in performing excision of a suspicious lesion followed by histological examination may be potentially harmful to the patient.
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Procedure Codes and Billing
Guidelines:
- To report provider services, use appropriate CPT* codes, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD-9 diagnostic codes.
- CPT code 96904 Whole body integumentary photography, for monitoring of high risk patients with dysplastic nevus syndrome or a history of dysplastic nevi, or patients with a personal or familial history of melanoma
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Selected References:
- Carli P, DeGiorgi V, Giannotti B. Dermoscopy as a second step in the diagnosis of doubtful pigmented skin lesions: how great is the risk of missing a melanoma? Journal of the European Academy of Dermatology and Venereology 2001 Jan; 15(1):24-6.
- Sante M, De Giorgi V, Cappugi P, Giannotti B, Carli P. Non-invasive analysis of melanoma thickness by means of dermoscopy: a retrospective study. Melanoma Research 2001 Apr;11 (2):147-52
- Elbaum M, Kopf AW, Rabinovitz HS, Langely RG, Kamino H, Mihm MC Jr, Sober AJ, Peck GL, Bogdan A, Gutkowicz-Krusin D, Greenebaum M, Keem S, Oliviero M, Wang S. Automatic differentiation of melanoma from melanocytic nevi with multi spectral digital dermoscopy: a feasibility study. Journal of the American Academy of Dermatology 2001 Feb; 44 (2): 207-8.
- Argenziano G, Puig S, Zalaudek I et al. Dermoscopy improved accuracy of primary care physicians to triage lesions suggestive of skin cancer. J Clin Oncol 2006; 24(12):1877-82.
- ECRI. Dermoscopy for Diagnosis of Melanoma and Other Forms of Malignancy: ECRI Health Technology Assessment Information Service; June 2004, Issue No.109
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New information or technology that would be relevant for Wellmark to consider when this policy is next reviewed may be submitted to:
Wellmark Blue Cross and Blue Shield
Medical Policy Analyst
Station 304
636 Grand Ave
Des Moines, Iowa 50309
*Current Procedural Terminology © 2008 American Medical Association. All Rights Reserved.
Wellmark medical policies address the complex issue
of technology assessment of new and emerging treatments, devices,
drugs, etc. They are developed to
assist in administering plan benefits and constitute neither offers of
coverage nor medical advice. Wellmark medical policies contain only a
partial, general description of plan or program benefits and do not
constitute a contract. Wellmark does not provide health care services
and, therefore, cannot guarantee any results or outcomes.
Participating providers are independent contractors in private
practice and are neither employees nor agents of Wellmark or its
affiliates. Treating providers are solely responsible for medical
advice and treatment of members. Our medical policies may be updated
and therefore are subject to change without notice.
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