C43.4

C43.4: Malignant melanoma of scalp and neck

Billable / specific codeICD-10-CM

C43.4 is a billable, specific ICD-10-CM code for malignant melanoma of scalp and neck. It is valid for submission on a claim.

Check C43.4 with the rest of the claim: free scrubber

Excludes1 inherited from the categories above C43.4

A category’s note binds every code beneath it.

Written on C43: Malignant melanoma of skin

melanoma in situ (D03.-)

Excludes2 inherited from the categories above C43.4

Not part of this code, but both may be coded when both are present.

Written on C43: Malignant melanoma of skin

malignant melanoma of skin of genital organs (C51-C52, C60.-, C63.-)
Merkel cell carcinoma (C4A.-)
sites other than skin-code to malignant neoplasm of the site

Other codes that can never be billed with C43.4

Their own Excludes1 notes name this code, so the conflict is not listed above.

C44Other and unspecified malignant neoplasm of skin

Risk adjustment

C43.4 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 23 Prostate, Breast, and Other Cancers and Tumors0.186 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

C43.4 is named in 77 Medicare coverage policies: 77 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

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