C13.9
BillableMalignant neoplasm of hypopharynx, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C13.9 an HCC code?
Yes. C13.9 maps to Lymphoma and Other Cancers under the CMS-HCC V28 risk adjustment model (and Colorectal, Bladder, and Other Cancers 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 C13.9
For C13.9to 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 C13.9 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C13.9 is the ICD-10-CM diagnosis code for malignant neoplasm of hypopharynx, unspecified. Cancer of the hypopharynx when the specific location within this region is not identified or documented. C13.9 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering malignant neoplasms of lip, oral cavity and pharynx (c00-c14).
Under the CMS-HCC V28 risk adjustment model, C13.9 maps to Lymphoma and Other Cancers (HCC 21) with a community, non-dual, aged base RAF weight of 0.671. Under the older CMS-HCC V24 model, C13.9 maps to Colorectal, Bladder, and Other Cancers (HCC 11) with a community, non-dual, aged base RAF weight of 0.307. 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.
This is a non-specific code; attempt to obtain more detailed anatomical information from pathology or imaging reports. Because C13.9 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 C13.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a non-specific code; attempt to obtain more detailed anatomical information from pathology or imaging reports
- •Query the provider to determine if the tumor involves pyriform sinus, postcricoid region, or other specific hypopharyngeal sites
Clinical Significance
Malignant neoplasm of hypopharynx, unspecified, indicates documentation does not specify the hypopharyngeal subsite. Given that endoscopy and cross-sectional imaging are standard in hypopharyngeal cancer workup, this code should prompt review of specialist reports for more specific site information.
Documentation Requirements
- ✓Pathology confirmation of hypopharyngeal malignancy
- ✓Documentation of imaging and endoscopy review for subsite detail
- ✓Provider query to ENT or head/neck oncologist for specific location
- ✓Complete staging information
- ✓Explanation for why specific subsite cannot be determined
Commonly Confused Codes
- •C12 — Pyriform sinus; the most common hypopharyngeal cancer site — check endoscopy
- •C13.0 — Postcricoid region; check if tumor is behind the cricoid cartilage
- •C14.0 — Pharynx, unspecified; even less specific — at least C13.9 identifies the hypopharynx
- •C13.8 — Overlapping sites; use when multiple known subsites are involved