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C39.0 ICD-10-CM Code: Malignant neoplasm of upper respiratory tract, part unspecified

C39.0 maps to CMS-HCC V28 21. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

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Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupC39.0

FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neoplasms of respiratory and intrathoracic organs (C30-C39)

C39.0

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Malignant neoplasm of upper respiratory tract, part unspecified

Cancer of the upper respiratory tract (nose, throat, and upper airways) when the specific location is not identified.

Buddy the Bee presenting code insight

Buddy Insight

Unspecified upper respiratory tract cancer is used when malignancy is confirmed in the upper airways but the specific site (nasal cavity, sinuses, larynx, pharynx) cannot be determined.

OverviewRisk ModelsCode BookDocumentationAuditNotesEdition comparison

CMS-HCC V28

HCC 21

Coefficient HCC 21: 0.671 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

HCC 011

Code-level coefficient reference

ESRD/PACE

HCC 11

Code-level coefficient reference

RXHCC

HCC 22

Code-level coefficient reference

Code Book Path

Official
C39Malignant neoplasm of other and ill-defined sites in the respiratory system and intrathoracic organsC39.0Malignant neoplasm of upper respiratory tract, part unspecified

Inclusion Terms

Official

No inclusion terms are included in this display for C39.0. Check the code and parent instructions in the Code Book.

Excludes 2

Official

No Excludes 2 notes are included in this display for C39.0. Check the code and parent instructions in the Code Book.

Related Codes

Official
C39.9Malignant neoplasm of lower respiratory tract, part unspecified

Includes

Official
  • malignant neoplasm of middle earInherited from C30-C39

Excludes 1

Official
  • mesothelioma (C45.-)Inherited from C30-C39, C39
  • intrathoracic malignant neoplasm NOS (C76.1)Inherited from C30-C39, C39
  • thoracic malignant neoplasm NOS (C76.1)Inherited from C30-C39, C39

Code First

Official

No Code First sequencing instructions are included in this display for C39.0. Check the code and parent instructions in the Code Book.

Use Additional

Official
  • code to identify:Inherited from C39
  • exposure to environmental tobacco smoke (Z77.22)Inherited from C39
  • exposure to tobacco smoke in the perinatal period (P96.81)Inherited from C39
  • history of tobacco dependence (Z87.891)Inherited from C39
  • occupational exposure to environmental tobacco smoke (Z57.31)Inherited from C39
  • tobacco dependence (F17.-)Inherited from C39
  • tobacco use (Z72.0)Inherited from C39

Code Also

Official

No Code Also instructions are included in this display for C39.0. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance
Pathology or clinical confirmation of upper respiratory tract malignancy
Evidence that all imaging, endoscopy, and pathology reports were reviewed
Provider query for specific anatomical site
Treatment status and clinical stage

MEAT Support

HCC Buddy guidance
Pathology or clinical confirmation of upper respiratory tract malignancy
Evidence that all imaging, endoscopy, and pathology reports were reviewed
Provider query for specific anatomical site
Treatment status and clinical stage

Audit Caution

HCC Buddy guidance
Using this non-specific code when ENT evaluation typically identifies the exact site
Not reviewing endoscopy, CT, or MRI reports that usually provide anatomical detail
Confusing upper respiratory tract cancer with pharyngeal cancers which have their own codes
Failing to query the provider for site specificity — especially important for risk adjustment

Common Mistakes

HCC Buddy guidance
C30.0 — Nasal cavity: Most specific upper respiratory site code
C31.x — Paranasal sinus codes: Review sinus imaging for specific sinus location
C32.x — Laryngeal codes: Laryngoscopy typically identifies the subsite
C39.9 — Lower respiratory tract, unspecified: Upper vs. lower distinction is important

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is C39.0 an HCC code?

Yes. C39.0 (Malignant neoplasm of upper respiratory tract, part unspecified) maps to HCC 21, Lymphoma and Other Cancers under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.671. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: C39.0 is billable and maps to V28 HCC 21, Lymphoma and Other Cancers. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
C39.0
Description
Malignant neoplasm of upper respiratory tract, part unspecified
HCC (V28)
HCC 21 — Lymphoma and Other Cancers
RAF reference coefficient
0.671
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 21, Lymphoma and Other Cancers
0.671
ESRDHCC 11, Colorectal/Bladder/and Other Cancers
Not separately weighted
RxHCCHCC 22, Prostate, Breast, Bladder, and Other Cancers and Tumors
Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work C39.0 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for C39.0

For C39.0, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

  • 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

Coder workflow notes

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What This Code Means

C39.0 is the ICD-10-CM diagnosis code for malignant neoplasm of upper respiratory tract, part unspecified. Cancer of the upper respiratory tract (nose, throat, and upper airways) when the specific location is not identified. C39.0 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering malignant neoplasms of respiratory and intrathoracic organs (c30-c39).

Under the CMS-HCC V28 risk adjustment model, C39.0 maps to Lymphoma and Other Cancers (HCC 21) with a source-labeled community, non-dual, aged reference coefficient of 0.671. No V24 mapping is shown for C39.0; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

This is a non-specific code; attempt to identify the exact site (larynx, pharynx, etc.) for more precise coding. For C39.0, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for C39.0 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 identify the exact site (larynx, pharynx, etc.) for more precise coding
  • •Review pathology and imaging reports for specific anatomical location

Clinical Significance

Unspecified upper respiratory tract cancer is used when malignancy is confirmed in the upper airways but the specific site (nasal cavity, sinuses, larynx, pharynx) cannot be determined. This is a documentation gap that should prompt extensive record review, as treatment and prognosis differ dramatically by upper respiratory subsite.

Documentation Requirements

  • ✓Pathology or clinical confirmation of upper respiratory tract malignancy
  • ✓Evidence that all imaging, endoscopy, and pathology reports were reviewed
  • ✓Provider query for specific anatomical site
  • ✓Treatment status and clinical stage
  • ✓Reason for inability to determine specific site

Commonly Confused Codes

  • •C30.0: Nasal cavity: Most specific upper respiratory site code
  • •C31.x: Paranasal sinus codes: Review sinus imaging for specific sinus location
  • •C32.x: Laryngeal codes: Laryngoscopy typically identifies the subsite
  • •C39.9: Lower respiratory tract, unspecified: Upper vs. lower distinction is important

Child Codes

C39.0Malignant neoplasm of upper respiratory tract, part unspecified
HCC 21
C39.9Malignant neoplasm of lower respiratory tract, part unspecified
HCC 21

Code Hierarchy

└C39Malignant neoplasm of other and ill-defined sites in the respiratory system and intrathoracic organs└C39.0Malignant neoplasm of upper respiratory tract, part unspecified
└C39.0Malignant neoplasm of upper respiratory tract, part unspecified

Also searched as

  • C39 0
  • C390

For C39.0, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

C39.0 maps to CMS-HCC V28 category 21, Lymphoma and Other Cancers. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. The mapping identifies a payment HCC category for C39.0. Review its source-labeled HCC coefficient above, check the RAF Calculator with complete member context for CMS-HCC V28 PY2026, and confirm the documentation the chart needs before the code is submitted. HCC Buddy shows no RAF score unless every required source and calculation check passes.

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