C00.0 — Malignant neoplasm of external upper lip
C00.0 is a billable, specific ICD-10-CM code for malignant neoplasm of external upper lip. It is valid for submission on a claim.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Malignant neoplasm of lipstick area of upper lip
- Malignant neoplasm of upper lip NOS
- Malignant neoplasm of vermilion border of upper lip
Other codes that can never be billed with C00.0
These codes carry an Excludes1 note pointing at C00.0. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading C00.0 alone.
Risk adjustment
C00.0 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
C00.0 is named in 62 Medicare coverage policies — 62 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
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Related codes at this level
Codes that share C00. If C00.0 is not quite right, the correct code is usually one of these.
- C00.1Malignant neoplasm of external lower lip
- C00.2Malignant neoplasm of external lip, unspecified
- C00.3Malignant neoplasm of upper lip, inner aspect
- C00.4Malignant neoplasm of lower lip, inner aspect
- C00.5Malignant neoplasm of lip, unspecified, inner aspect
- C00.6Malignant neoplasm of commissure of lip, unspecified
- C00.8Malignant neoplasm of overlapping sites of lip
- C00.9Malignant neoplasm of lip, unspecified
Questions about C00.0
- Is C00.0 a billable ICD-10-CM code?
- Yes. C00.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does C00.0 sit in the tabular list?
- Neoplasms (C00-D49), in the block Malignant neoplasms of lip, oral cavity and pharynx (C00-C14).