HCPCS Level II M1390: Missing Exam for Melanoma Recurrence - OpenPayer

Summary & Overview

HCPCS Level II M1390: Missing Exam for Melanoma Recurrence

HCPCS Level II code M1390 flags patient records where an exam for recurrence of melanoma was not documented during the performance period. Nationally, such codes are important for quality measurement, care coordination, and documentation audits because melanoma surveillance is time-sensitive and impacts follow-up care pathways. The code itself is an administrative marker rather than a treatment or procedure code and is used in chart review, quality reporting, and payer compliance checks.

Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what M1390 represents, the clinical and administrative contexts in which it appears, and what typical benchmarks and policy considerations accompany documentation-focused HCPCS Level II codes. The publication outlines how M1390 relates to outpatient oncology or dermatology follow-up workflows, common implications for quality programs, and gaps often identified in documentation reviews.

The content addresses documentation and reporting implications, typical sites of service, and where this code fits into broader quality and compliance processes. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1390HCPCS Level IImelanoma surveillancedocumentationquality measurementoncology follow-updermatology follow-upperformance period

Billing Code Overview

HCPCS Level II code M1390 indicates a patient record in which no documented exam for recurrence of melanoma was performed or no documentation exists within the performance period. This code is used to denote missing or absent follow-up examination documentation related to melanoma surveillance.

Service type: Documentation of recurrence surveillance exam for melanoma
Typical site of service: Outpatient oncology or dermatology follow-up visits, clinic-based surveillance encounters

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with a prior stage IIIB cutaneous melanoma presents for routine surveillance during the performance period for an established melanoma follow-up program. The clinician's expected workflow is a focused skin and lymph node examination to assess for local recurrence or new primary melanoma, documentation of any suspicious lesions, and planning for biopsy or imaging if warranted. In this scenario, no documented exam for recurrence is present in the medical record during the performance period despite the patient encounter being billed, resulting in use of billing code M1390 to indicate that a documented exam for recurrence of melanoma was not performed or is absent in the record. Typical site of service is an outpatient dermatology or surgical oncology clinic; related visits may also occur in ambulatory infusion centers or hospital outpatient departments when patients present for routine surveillance. A realistic patient scenario: the patient attends a scheduled follow-up visit, a brief medication reconciliation and symptom check are documented, but there is no documented full skin and lymph node exam for melanoma recurrence during the performance period, and no documentation of counseling about signs of recurrence. Common payors for review of this episode include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

HCPCS M1269: ESRD MCP Dialysis on Last Day of Reporting Month

HCPCS-M1483-HCV-SUSTAINED-VIROLOGICAL-RESPONSE-20W-12MO

HCPCS M1483: HCV Sustained Virological Response (20 Weeks–12 Months)

HCPCS-M1489-PATIENT-STATUS-DOCUMENTED

HCPCS M1489: Patient Status Documented

HCPCS-M1332-INADEQUATE-INITIAL-EVALUATION-FOLLOW-UP

HCPCS M1332: Inadequate Initial Evaluation or Missed 2-Week Re-evaluation

HCPCS-M1265-CMS-MEDICAL-EVIDENCE-FORM-2728-INITIAL

HCPCS M1265: CMS Medical Evidence Form 2728, Initial Completion

HCPCS-M1464-FOLLOW-UP-DOCUMENTATION-DEFICIENCY

HCPCS Level II M1464: Missing Documentation of Follow-Up Attempts

HCPCS-M1293-BMI-ELEVATED-FOLLOW-UP-PLAN-DOCUMENTED

HCPCS Level II M1293: Elevated BMI with Follow-Up Plan Documented

HCPCS-M1442-TELEHEALTH-ENCOUNTER-VISIT-VIRTUAL-CARE

HCPCS Level II M1442: Telehealth Encounter / Virtual Visit

HCPCS-M1424-PULMONOLOGY-MIPS-VALUE-PATHWAY

HCPCS M1424: Pulmonology Care MIPS Value Pathway

HCPCS-M1486-SNF-ADMISSION-EVALUATION-PERIOD

HCPCS M1486: SNF Admission During Evaluation Period

Showing 1–10 of 356

Taxonomy Code	Specialty	Notes
`207Q00000X`	Dermatology	Primary specialty responsible for skin examinations and melanoma surveillance.
`207R00000X`	Surgical Oncology	Surgeons who perform melanoma resections and recurrence assessments.
`207L00000X`	Medical Oncology	Manages systemic surveillance and coordinates imaging for suspected recurrence.
`363A00000X`	Physician Assistant	Commonly documents follow-up visits and assists with procedures in dermatology/surgical oncology.
`103T00000X`	Nurse Practitioner	Frequently provides routine surveillance visits and documentation in outpatient clinics.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11102`	Tangential biopsy of skin (e.g., shave, scoop), single lesion	Performed when a suspicious lesion is identified during a skin exam for possible melanoma recurrence.
`11100`	Tangential biopsy of skin, single lesion, trunk, arms, legs, or mucous membrane	Alternative shave biopsy code used for suspicious lesions found on exam.
`11606`	Excision, malignant lesion, trunk, arms, or legs; excised diameter 1.1 to 2.0 cm	Performed when biopsy confirms recurrent or new primary melanoma requiring excision.
`88305`	Surgical pathology, gross and microscopic examination	Sent with biopsy or excision specimens to confirm melanoma recurrence or margin status.
`99213`	Office or other outpatient visit for established patient, typically 15 minutes	Typical visit level where a recurrence exam should be performed and documented; absence of exam may trigger `M1390`.
`96401`	Chemotherapy administration, subcutaneous/intramuscular; non-hormonal antineoplastic	Related when systemic therapy is initiated or continued for recurrent melanoma and documentation of surveillance is part of treatment visits.

OpenPayer