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v1.0.0
ICD-10 Guide
ICD-10 CodesC43.0

C43.0

Billable

Malignant melanoma of lip

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 C43.0 is a billable code used to indicate a diagnosis of malignant melanoma of lip.

Key Diagnostic Point:

Malignant melanoma of the lip is a type of skin cancer that originates from melanocytes, the pigment-producing cells in the skin. This condition is characterized by the uncontrolled growth of these cells, leading to the formation of malignant tumors. Melanoma of the lip is relatively rare compared to other forms of melanoma, but it can be aggressive and has a higher risk of metastasis. Diagnosis typically involves a thorough clinical examination, followed by a biopsy to confirm malignancy. Staging of melanoma is crucial for determining the appropriate treatment plan and prognosis. The Breslow thickness, which measures the depth of the tumor in millimeters, is a key factor in staging and prognosis; thicker tumors generally indicate a worse prognosis. Sentinel lymph node biopsy is often performed to assess whether cancer has spread to nearby lymph nodes, which is critical for staging and treatment decisions. Early detection and treatment are vital for improving outcomes in patients with malignant melanoma of the lip.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in staging criteria based on Breslow thickness
  • Need for accurate documentation of biopsy results
  • Differentiation from other types of lip lesions
  • Potential for metastasis requiring additional coding

Audit Risk Factors

  • Inaccurate staging documentation
  • Failure to document Breslow thickness
  • Misclassification of melanoma type
  • Inadequate follow-up documentation

Specialty Focus

Medical Specialties

Dermatology

Documentation Requirements

Detailed clinical notes on lesion characteristics, biopsy results, and staging information.

Common Clinical Scenarios

Diagnosis and treatment of melanoma, follow-up care for melanoma patients, and management of complications.

Billing Considerations

Ensure accurate documentation of tumor characteristics and staging to support coding.

Oncology

Documentation Requirements

Comprehensive treatment plans, including surgical and adjuvant therapies, and follow-up care.

Common Clinical Scenarios

Management of advanced melanoma, coordination of care with surgical teams, and monitoring for recurrence.

Billing Considerations

Document all treatment modalities and patient responses to ensure accurate coding and billing.

Coding Guidelines

Inclusion Criteria

Use C43.0 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the diagnosis, staging, and any associated procedures
  • Include details on Breslow thickness and lymph node involvement when applicable

Exclusion Criteria

Do NOT use C43.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

11600CPT Code

Excision, malignant skin lesion

Clinical Scenario

Used when excising a melanoma from the lip.

Documentation Requirements

Document the size of the lesion and margins excised.

Specialty Considerations

Dermatologists should ensure accurate measurement and documentation of the excised area.

38500CPT Code

Sentinel lymph node biopsy

Clinical Scenario

Performed to assess lymph node involvement in melanoma cases.

Documentation Requirements

Document indications for the biopsy and results.

Specialty Considerations

Oncologists must ensure clear documentation of staging and treatment planning.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of melanoma types, improving data accuracy and treatment tracking. C43.0 provides a clear distinction for malignant melanoma of the lip, which aids in research and treatment protocols.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of melanoma types, improving data accuracy and treatment tracking. C43.0 provides a clear distinction for malignant melanoma of the lip, which aids in research and treatment protocols.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of melanoma types, improving data accuracy and treatment tracking. C43.0 provides a clear distinction for malignant melanoma of the lip, which aids in research and treatment protocols.

Resources

Clinical References

  • •
    American Academy of Dermatology
  • •
    National Comprehensive Cancer Network (NCCN)

Coding & Billing References

  • •
    American Academy of Dermatology
  • •
    National Comprehensive Cancer Network (NCCN)

Frequently Asked Questions

What is the significance of Breslow thickness in melanoma coding?

Breslow thickness is crucial for staging melanoma and determining prognosis. It directly influences treatment decisions and coding accuracy.

How do I document a sentinel lymph node biopsy for melanoma?

Document the indication for the biopsy, the results, and any subsequent treatment plans to ensure accurate coding and billing.