Medications Used for the Treatment of Melanoma (Skin Cancer) and Associated ICD-10 Codes

Kristin A. Esposito, CPhT

June 2017, Vol 7, No 6 - Cancer Drug Coding


This detailed article of codes related to melanoma (skin cancer) is intended to assist practice managers and other healthcare providers and payers to ensure the proper use of coding and billing information associated with the treatment of patients with melanoma.

The following sections include:

  • Associated ICD-10-CM codes used for the classification of melanoma
  • Drugs that have been approved by the FDA for the treatment of melanoma
  • Drugs that are Compendia-listed for off-label use for melanoma based on clinical studies that suggest beneficial use in some cases. Please note: If a check mark appears in the FDA column, it will NOT appear in the Compendia off-label use column
  • Corresponding HCPCS/CPT® codes and code descriptions
  • Possible CPT® administration codes for the drugs

Associated ICD-10-CM Codes:

C43 Malignant melanoma of skin
  C43.0 Malignant melanoma of lip
  C43.1 Malignant melanoma of eyelid, including canthus
  C43.10 Malignant melanoma of unspecified eyelid, including canthus
  C43.11 Malignant melanoma of right eyelid, including canthus
  C43.12 Malignant melanoma of left eyelid, including canthus
  C43.2 Malignant melanoma of ear and external auricular canal
  C43.20 Malignant melanoma of unspecified ear and external auricular canal
  C43.21 Malignant melanoma of right ear and external auricular canal
  C43.22 Malignant melanoma of left ear and external auricular canal
  C43.3 Malignant melanoma of other and unspecified parts of face
  C43.30 Malignant melanoma of unspecified part of face
  C43.31 Malignant melanoma of nose
  C43.39 Malignant melanoma of other parts of face
  C43.4 Malignant melanoma of scalp and neck
  C43.5 Malignant melanoma of trunk
  C43.51 Malignant melanoma of anal skin
  C43.52 Malignant melanoma of skin of breast
  C43.59 Malignant melanoma of other part of trunk
  C43.6 Malignant melanoma of upper limb, including shoulder
  C43.60 Malignant melanoma of unspecified upper limb, including shoulder
  C43.61 Malignant melanoma of right upper limb, including shoulder
  C43.62 Malignant melanoma of left upper limb, including shoulder
  C43.7 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
  C43.8 Malignant melanoma of overlapping sites of skin
  C43.9 Malignant melanoma of skin, unspecified
Generic (brand) name HCPCS code—code description FDA approved for melanoma (skin cancer) Compendia off-label uses for melanoma (skin cancer) Possible CPT® administration codes
aldesleukin (Proleukin) J9015 – Injection, aldesleukin, per single-use vial   96409
amifostine (Ethyol) J0207 – Injection, amifostine, 500 mg   96374
Bacillus Calmette-Guérin (BCG Vaccine) 90585 – Bacillus Calmette-Guérin vaccine (BCG) for tuberculosis, live, for percutaneous use   90471, 90472
Bacillus Calmette-Guérin (Tice BCG, TheraCys) 90586 – Bacillus Calmette-Guérin vaccine (BCG) for bladder cancer, live, for intravesical use   51720
Bacillus Calmette-Guérin (Tice BCG, TheraCys) J9031 – bCG (intravesical), per installation   51720
bleomycin (Blenoxane) J9040 – Injection, bleomycin sulfate,
15 units
  96401, 96409
carboplatin (Paraplatin) J9045 – Injection, carboplatin, 50 mg   96409, 96413, 96415
carmustine (BiCNU) J9050 – Injection, carmustine, 100 mg   96413, 96415
cisplatin (Platinol AQ) J9060 – Injection, cisplatin, powder or solution, per 10 mg   96409, 96413, 96415
cobimetinib (Cotellic) C9399* – Unclassified drugs or biologicals (Hospital outpatient use only)   N/A
cobimetinib (Cotellic) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
dabrafenib (Tafinlar) C9399* – Unclassified drugs or biologicals (Hospital outpatient use only)   N/A
dabrafenib (Tafinlar) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
dacarbazine (DTIC-Dome) J9130 – Dacarbazine, 100 mg   96409, 96413
dactinomycin (Cosmegen) J9120 – Injection, dactinomycin, 0.5 mg   96409
docetaxel (Taxotere) J9171 – Injection, docetaxel, 1 mg   96413
interferon alfa-2b (Intron-A) J9214 – Injection, interferon, alfa-2b, recombinant, 1 million units   96372, 96401
ipilimumab (Yervoy) J9228 – Injection, ipilimumab, 1 mg   96413, 96415
lomustine (CeeNu) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
lomustine (CeeNu) S0178 – Lomustine, oral, 10 mg   N/A
megestrol acetate (Megace) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
megestrol acetate (Megace) S0179 – Megestrol acetate, oral 20 mg   N/A
melphalan (Alkeran) J9245 – Injection, melphalan hydrochloride, 50 mg   96409, 96413
nivolumab (Opdivo) J9299 – Injection, nivolumab, 1 mg   96413, 96415
paclitaxel (Taxol) J9265 – Injection, paclitaxel, 30 mg   96413, 96415
peginterferon alfa-2b (Sylatron) C9399* – Unclassified drugs or biologicals (Hospital outpatient use only)   96372, 96401
peginterferon alfa-2b (Sylatron) J9999* – Not otherwise classified, antineoplastic drugs   96372, 96401
pembrolizumab (Keytruda) J9271 – Injection, pembrolizumab, 1 mg   96413
sargramostim (Leukine) J2820 – Injection, sargramostim (GM-CSF), 50 mcg   96365, 96366, 96372
talimogene laherparepvec (Imlygic) J9325 – Injection, talimogene laherparepvec, per 1 million plaque- forming units   96405, 96406
temozolomide (Temodar) J8700 – Temozolomide, oral, 5 mg   N/A
trametinib (Mekinist) C9399* – Unclassified drugs or biologicals (Hospital outpatient use only)   N/A
trametinib (Mekinist) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
vemurafenib (Zelboraf) C9399* – Unclassified drugs or biologicals (Hospital outpatient use only)   N/A
vemurafenib (Zelboraf) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
vinBLAStine (Velban) J9360 – Injection, vinblastine sulfate,
1 mg
  96409
vinCRIStine (Vincasar PFS) J9370 – Vincristine sulfate, 1 mg   96409
*When billing a nonclassified medication using a CMS 1500 claim form you must include both the HCPCS code (eg, J8999 Zelboraf) in Item 24D and the drug name, strength, and NDC (National Drug Code) in Item 19 or 24A (shaded area) to ensure appropriate reimbursement. Please note: Check with payer regarding correct placement of medication information.
References
• HCPCS Level II Expert 2017
Current Procedural Terminology (CPT®) 2017
CPT Copyright © 2017 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association
ICD-10-CM for Professionals Volumes 1 & 2 2017
• FDA-approved indication (product Prescribing Information)
• Compendia references available upon request
• www.ReimbursementCodes.com powered by RJ Health Systems International, LLC, Rocky Hill, CT
• CMS (Centers for Medicare & Medicaid Services)
GM-CSF indicates granulocyte-macrophage colony-stimulating factor; HCPCS, Healthcare Common Procedure Coding System.
RJ Health Systems