Valid for Submission
C43.0 is a billable diagnosis code used to specify a medical diagnosis of malignant melanoma of lip. The code C43.0 is valid during the fiscal year 2022 from October 01, 2021 through September 30, 2022 for the submission of HIPAA-covered transactions.
The ICD-10-CM code C43.0 might also be used to specify conditions or terms like malignant melanoma of lip, malignant melanoma of skin of lip, malignant melanoma of skin of lower lip or malignant melanoma of skin of upper lip.
The code C43.0 is linked to some Quality Measures as part of Medicare's Quality Payment Program (QPP). When this code is used as part of a patient's medical record the following Quality Measures might apply: Melanoma Reporting.
Tabular List of Diseases and Injuries
The Tabular List of Diseases and Injuries is a list of ICD-10 codes, organized "head to toe" into chapters and sections with coding notes and guidance for inclusions, exclusions, descriptions and more. The following references are applicable to the code C43.0:
Type 1 ExcludesType 1 Excludes
A type 1 excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
Index to Diseases and Injuries
The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10 code(s). The following references for the code C43.0 are found in the index:
The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:
- Malignant melanoma of lip
- Malignant melanoma of skin of lip
- Malignant melanoma of skin of lower lip
- Malignant melanoma of skin of upper lip
Diagnostic Related Groups - MS-DRG Mapping
|MS-DRG||MS-DRG Title||MCD||Relative Weight|
|595||MAJOR SKIN DISORDERS WITH MCC||09||2.0121|
|596||MAJOR SKIN DISORDERS WITHOUT MCC||09||0.9892|
The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.
Convert C43.0 to ICD-9 Code
The General Equivalency Mapping (GEM) crosswalk indicates an approximate mapping between the ICD-10 code C43.0 its ICD-9 equivalent. The approximate mapping means there is not an exact match between the ICD-10 code and the ICD-9 code and the mapped code is not a precise representation of the original code.
Quality Payment Program Measures
When code C43.0 is part of the patient's diagnoses the following Quality Measures apply and affect reimbursement. The objective of Medicare's Quality Measures is to improve patient care by making it more: effective, safe, efficient, patient-centered and equitable.
|Quality Measure||Description||Quality Domain||Measure Type||High Priority||Submission Methods|
|Melanoma Reporting||Pathology reports for primary malignant cutaneous melanoma that include the pT category and a statement on thickness, ulceration and mitotic rate.||Communication and Care Coordination||Process||YES||Claims, Registry|
Information for Patients
Melanoma is the most serious type of skin cancer. Often the first sign of melanoma is a change in the size, shape, color, or feel of a mole. Most melanomas have a black or black-blue area. Melanoma may also appear as a new mole. It may be black, abnormal, or "ugly looking."
Thinking of "ABCDE" can help you remember what to watch for:
- Asymmetry - the shape of one half does not match the other
- Border - the edges are ragged, blurred or irregular
- Color - the color is uneven and may include shades of black, brown and tan
- Diameter - there is a change in size, usually an increase
- Evolving - the mole has changed over the past few weeks or months
Surgery is the first treatment of all stages of melanoma. Other treatments include chemotherapy and radiation, biologic, and targeted therapies. Biologic therapy boosts your body's own ability to fight cancer. Targeted therapy uses substances that attack cancer cells without harming normal cells.
NIH: National Cancer Institute
[Learn More in MedlinePlus]
Melanoma Summary Learn about melanoma risk factors, symptoms, tests to diagnose, factors affecting prognosis, staging, and treatment.
[Learn More in MedlinePlus]