2027 ICD-10-CM Diagnosis Code C43.111Malignant melanoma of right upper eyelid, including canthus
ICD-10-CM Codes›C00–D49›C43-C44›C43
- Billable — Valid for Submission
- Risk Adjusts — HCC 23
- Chronic Condition
C43.111 is a billable ICD-10-CM diagnosis code for malignant melanoma of right upper eyelid, including canthus. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 124 through 125. Coders also document this condition as malignant melanoma of eyelid. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Skin cancers - melanoma.
For Medicare Advantage risk adjustment, C43.111 maps to CMS-HCC Category 23 (Prostate, Breast, and Other Cancers and Tumors) under the V28 model, adding a risk factor of about 0.186 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
C43.111 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Malignant melanoma of eyelid
- Malignant melanoma of skin of eyelid
- Malignant melanoma of skin of right upper eyelid
- Malignant melanoma of skin of upper eyelid
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to C43.111: its own notes plus those printed at C43 and Chapter 2. A note printed at a category, block or chapter applies to every code under it.
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
Notes
General instructions on how these codes are used.
- Functional activity
- All neoplasms are classified in this chapter, whether they are functionally active or not. An additional code from Chapter 4 may be used, to identify functional activity associated with any neoplasm.
- Morphology [Histology]
- Chapter 2 classifies neoplasms primarily by site (topography), with broad groupings for behavior, malignant, in situ, benign, etc. The Table of Neoplasms should be used to identify the correct topography code. In a few cases, such as for malignant melanoma and certain neuroendocrine tumors, the morphology (histologic type) is included in the category and codes.
- Primary malignant neoplasms overlapping site boundaries
- A primary malignant neoplasm that overlaps two or more contiguous (next to each other) sites should be classified to the subcategory/code .8 ('overlapping lesion'), unless the combination is specifically indexed elsewhere. For multiple neoplasms of the same site that are not contiguous, such as tumors in different quadrants of the same breast, codes for each site should be assigned.
- Malignant neoplasm of ectopic tissue
- Malignant neoplasms of ectopic tissue are to be coded to the site mentioned, e.g., ectopic pancreatic malignant neoplasms are coded to pancreas, unspecified (C25.9).
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name C43.111, its category, or a range that includes it.
Applicable To 1
These notes mention C43.111.
Excludes1 2
These codes carry an Excludes1 note naming C43.111: they are not reported together with it, unless the two conditions are unrelated.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Eyelid Melanoma
a melanoma that arises from the upper or lower eyelid.
Patient EducationClinical
Eyelid Disorders
Eyelid disorders include a variety of conditions that affect your eyelids. Your eyelids protect your eyes and help keep them healthy. When you blink, they spread tears across your eyes and help wash away dirt or dust. You also close your eyelids when something comes near your eyes to protect them from injury.
The full article covers:
- What are eyelid disorders?
- What causes eyelid disorders?
- What are common eyelid disorders?
- What are the symptoms of eyelid disorders?
- How are eyelid disorders diagnosed?
- How are eyelid disorders treated?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Code History & ChangesHistory
Replacement C43.111 replaces the following previously assigned code(s):
- C43.11 - Malignant melanoma of right eyelid, including canthus
Questions About C43.111Overview
What is the ICD-10 code for malignant melanoma of right upper eyelid, including canthus?
The ICD-10-CM code for malignant melanoma of right upper eyelid, including canthus is C43.111 (sometimes written as C43111). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is C43.111 (Malignant melanoma of right eyelid, including canthus) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report malignant melanoma of right upper eyelid, including canthus on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does C43.111 group to?
When malignant melanoma of right upper eyelid, including canthus is the principal diagnosis on an inpatient stay, it groups to MS-DRG 125, 124, with relative weights from 0.7699 to 1.2470 depending on complications. Higher weights mean higher Medicare reimbursement.
Can C43.111 be reported with a code from D03?
Not as a rule. The Excludes1 note at C43, which applies to C43.111, lists "melanoma in situ (D03.-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What HCC is C43.111?
C43.111 (malignant melanoma of right upper eyelid, including canthus) maps to CMS-HCC Category 23 (Prostate, Breast, and Other Cancers and Tumors), commonly written as HCC 23, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 12 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 22.
Does C43.111 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, C43.111 adds a risk adjustment factor of about 0.186 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.186 to 0.237 depending on the payment segment). A more severe related category (HCC 17, HCC 18, HCC 19, HCC 20, HCC 21, and HCC 22) supersedes it when both are reported. See the full factor table on the HCC 23 category page.
