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ICD-10-CM Coding for Melanoma and Melanoma in Situ

By Lauri Gray
May 02, 2012

In ICD-10-CM, melanoma must now be differentiated as melanoma or melanoma in situ. Melanoma is reported with codes from category C43, while melanoma in situ is reported with codes in category D03. In order to better understand ICD-10-CM classification of these two conditions, one must understand the definitions of these terms and how melanomas are staged.

Definitions

Melanoma in situ – Malignant neoplasm of the melanin (brown pigment producing) cells that is documented as in situ which includes melanoma that is described as follows:

  • Stage 0
  • Tis (tumor in situ)
  • Epidermal layer only

Malignant melanoma Malignant neoplasm of the melanin (brown pigment producing) cells that is described as having invaded the dermis or as one of the following stages:

  • Stage I – localized
    • Stage IA – less than 1.0 mm thick, no ulceration, no lymph node involvement, no distant metastases
    • Stage 1B – less than 1.0 mm thick with ulceration or less than 2.0 mm thick without ulceration, no lymph node involvement, no distant metastases
  • Stage II – localized
    • Stage IIA – 1.01-2.00 mm thick with ulceration, no lymph node involvement, no distant metastases
    • Stage IIB – 2.01-4.00 mm thick without ulceration, no lymph node involvement, no distant metastases
    • Stage IIC – greater than 4.00 mm thick with ulceration, no lymph node involvement, no distant metastases
  • Stage III – tumor spread to regional lymph nodes or development of in transit metastases or satellites without spread to distant sites. Three substages IIIA, IIIB, IIIC.
  • Stage IV – tumor spread beyond regional lymph nodes with metastases to distant sites

ICD-9-CM versus ICD-10-CM

In ICD-9-CM category 172 is specific to general body sites and includes both malignant melanoma that has invaded deeper layers of skin beyond top layer and melanoma in situ (Stage 0, top layer of skin only).

In ICD-10-CM, documentation is required specifying whether the melanoma is in situ (D03.-) or has invaded deeper layers of skin (C43.-). Body sites are much more specific and require documentation of laterality for paired body parts (eyes, ears, upper limb, lower limb).

Coding and Documentation Requirements

The two checklists below describe the documentation elements required to assign the most specific code in ICD-9-CM and in ICD-10-CM.

ICD-9-CM Coding and Documentation Requirements

  • Identify site as
    • Lip
    • Eyelid
    • Ear/external auditory canal
    • Other/unspecified parts of face
    • Scalp/neck
    • Trunk, except scrotum
    • Upper limb, including shoulder
    • Lower limb, including hip
    • Other specified/overlapping sites
    • Unspecified site

ICD-10-CM Coding and Documentation Requirements

  • Identify stage or depth of lesion
    • Melanoma in situ  (Stage 0, classification TIS or epidermal layer only)
    • Malignant melanoma (Stages I-IV or invasion of dermal layer)
  • Identify site as
    • Lip
    • Eyelid
      • Right
      • Left
      • Unspecified
      • Ear/external auricular canal
        • Right
        • Left
        • Unspecified
      • Nose
      • Other specified parts of face
      • Unspecified parts of face
      • Scalp/neck
      • Anal skin
      • Breast
      • Other parts of trunk
      • Upper limb, including shoulder
        • Right
        • Left
        • Unspecified
      • Lower limb, including hip
        • Right
        • Left
        • Unspecified
      • Overlapping sites
      • Unspecified site

Coding Scenario

Forty-five-year-old Caucasian female presented to dermatologist’s office for annual skin check. At that time, a 0.5 x 1 cm scaly brown patch of skin on the dorsal aspect of right foot was noted. The lesion was biopsied and sent to pathology. Pathology report indicates melanoma epidermal layer only. Patient returns for wide excision of right foot lesion. Incision lines marked with surgical ink, area is prepped, draped and infiltrated with local anesthetic. Lesion excised using an elliptical incision with 1 cm clear margins on all sides. Specimen sent to pathology.  Incision undermined and closed in layers. Sterile dressing applied. Final diagnosis per pathology report: Melanoma Stage 0, right dorsal foot.

Malignant Melanoma/Melanoma in Situ Lower Extremity

ICD-9-CM Code/Documentation

ICD-10-CM Code/Documentation

172.7 Malignant melanoma of lower limb, including hip

 

C43.70 Malignant melanoma of unspecified lower limb, including hip

C43.71 Malignant melanoma of right lower limb, including hip

C43.72 Malignant melanoma of left lower limb, including hip

D03.70 Melanoma in situ of unspecified lower limb, including hip

D03.71 Melanoma in situ of right lower limb, including hip

D03.72 Melanoma in situ of left lower limb, including hip

ICD-9-CM Diagnosis Codes:

172.7 Malignant melanoma of lower limb, including hip

ICD-10-CM Diagnosis Codes:

D03.71 Melanoma in situ of right lower limb, including hip

Summary

Stage 0 melanoma is very early stage disease known as melanoma in situ. In ICD-10-CM, codes for melanoma in situ are found in category D03. Patients with melanoma in situ are classified as TIS (tumor in situ). The tumor is limited to the top layer of the skin (epidermis) with no evidence of invasion of dermis, surrounding tissues, lymph nodes, or distant sites. Melanoma in situ is very low risk for recurrence or metastasis.

 

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