D03.112
BillableMelanoma in situ of right lower eyelid, including canthus
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D03.112 an HCC code?
Yes. D03.112 maps to Melanoma and Other Skin Cancers under the CMS-HCC V28 risk adjustment model (and Breast, Prostate, and Other Cancers and Tumors under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for D03.112
For D03.112 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed D03.112 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D03.112 is the ICD-10-CM diagnosis code for melanoma in situ of right lower eyelid, including canthus. This is an early-stage skin cancer (melanoma) found on the right lower eyelid or the corner of the eye that has not yet spread to deeper layers of skin or other parts of the body. It is considered 'in situ,' meaning the cancer cells are confined to the outermost layer of skin. D03.112 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering in situ neoplasms (d00-d09).
Under the CMS-HCC V28 risk adjustment model, D03.112 maps to Melanoma and Other Skin Cancers (HCC 23) with a community, non-dual, aged base RAF weight of 0.251. Under the older CMS-HCC V24 model, D03.112 maps to Breast, Prostate, and Other Cancers and Tumors (HCC 12) with a community, non-dual, aged base RAF weight of 0.150. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
The sixth character '2' specifies the right side; use '1' for left side and '3' for bilateral when applicable. Because D03.112 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for D03.112 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •The sixth character '2' specifies the right side; use '1' for left side and '3' for bilateral when applicable
- •Verify documentation clearly identifies the specific eyelid location (lower, upper, or canthus) and laterality before assigning this code
Clinical Significance
Melanoma in situ of the right lower eyelid is an early melanocytic malignancy limited to the epidermal layer of the right lower eyelid and adjacent canthal area. Lower eyelid melanoma in situ may present as a slowly expanding pigmented lesion that can mimic benign conditions such as pigmented basal cell carcinoma or conjunctival melanosis. Complete excision with margin control is essential to prevent progression to invasive melanoma.
Documentation Requirements
- ✓Biopsy-confirmed melanoma in situ with pathology documenting epidermal confinement.
- ✓Right laterality and lower eyelid specificity must be clearly stated in the operative and pathology reports.
- ✓Post-excision margin assessment and follow-up surveillance schedule should be documented.