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C40.01 ICD-10-CM Code: Malignant neoplasm of scapula and long bones of right upper limb

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.

FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neoplasms of bone and articular cartilage (C40-C41)

C40.01

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

Malignant neoplasm of scapula and long bones of right upper limb

Cancer that starts in the shoulder blade or long bones of the right arm, including the upper arm and forearm bones.

Buddy the Bee presenting code insight

Buddy Insight

Right-sided bone cancer of the scapula and upper limb long bones specifies laterality, which is critical for surgical planning — limb-salvage procedures, reconstruction, and potential amputation decisions all depend on which side is affected.

CMS-HCC V28

HCC 21

RAF 0.545

CMS-HCC V24

HCC 10

RAF 0.675

ACA/HHS

0

0

RAF 0

ESRD/PACE

HCC 10

RAF 0.0

RXHCC

HCC 22

RAF 0.0

Code Trumping

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Code Book Path

Official
C40Malignant neoplasm of bone and articular cartilage of limbs
C40.0Malignant neoplasm of scapula and long bones of upper limb
C40.01Malignant neoplasm of scapula and long bones of right upper limb

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for C40.01 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for C40.01 in this effective period.

Related Child Codes

Official
C40.00Malignant neoplasm of scapula and long bones of unspecified upper limb
C40.02Malignant neoplasm of scapula and long bones of left upper limb

Includes

Official

ICD-10-CM does not list Includes notes for C40.01 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for C40.01 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for C40.01 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for C40.01 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for C40.01 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Pathology confirming primary bone malignancy with histological type and grade
Imaging confirming right-sided location with specific bone identification
Explicit right laterality documentation
TNM staging and assessment for limb-salvage candidacy

MEAT Support

HCC Buddy guidance
Pathology confirming primary bone malignancy with histological type and grade
Imaging confirming right-sided location with specific bone identification
Explicit right laterality documentation
TNM staging and assessment for limb-salvage candidacy

Audit Caution

HCC Buddy guidance
Reversing laterality — always verify from imaging and surgical documentation
Coding metastatic disease to the humerus or scapula as primary bone cancer
Not specifying which long bone (humerus, radius, ulna) is affected in documentation
Confusing primary bone sarcoma with soft tissue sarcoma eroding into bone

Common Mistakes

HCC Buddy guidance
C40.02 — Left upper limb long bones: Verify right laterality from documentation
C40.00 — Unspecified laterality: Use C40.01 when right side is documented
C79.51 — Secondary malignant neoplasm of bone: Confirm primary origin, not metastatic
C40.10-C40.12 — Short bones of upper limb (hand): Long bones are proximal; short bones are in the hand and wrist

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is C40.01 an HCC code?

Yes. C40.01 maps to Breast, Prostate, Colorectal and Other Cancers and Tumors under the CMS-HCC V28 risk adjustment model (and Lymphoma and Other Cancers under V24).

HCC Category Mapping

V28HCC 21, Breast, Prostate, Colorectal and Other Cancers and Tumors
0.545
V24HCC 10, Lymphoma and Other Cancers
0.675
ESRDHCC 10, Lymphoma and Other Cancers
0.000
RxHCCHCC 22, Cancer, Other Specified Sites
0.000

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 C40.01

For C40.01to 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 C40.01 during that encounter, not just copy-forwarded from a problem list.

What This Code Means

C40.01 is the ICD-10-CM diagnosis code for malignant neoplasm of scapula and long bones of right upper limb. Cancer that starts in the shoulder blade or long bones of the right arm, including the upper arm and forearm bones. C40.01 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering malignant neoplasms of bone and articular cartilage (c40-c41).

Under the CMS-HCC V28 risk adjustment model, C40.01 maps to Breast, Prostate, Colorectal and Other Cancers and Tumors (HCC 21) with a community, non-dual, aged base RAF weight of 0.545. Under the older CMS-HCC V24 model, C40.01 maps to Lymphoma and Other Cancers (HCC 10) with a community, non-dual, aged base RAF weight of 0.675. 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.

Verify laterality is documented as right; if documentation is unclear, query the provider before coding. Because C40.01 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 C40.01 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Verify laterality is documented as right; if documentation is unclear, query the provider before coding
  • •Long bones of upper limb include humerus, radius, and ulna; ensure the specific bone location is documented for accuracy

Clinical Significance

Right-sided bone cancer of the scapula and upper limb long bones specifies laterality, which is critical for surgical planning — limb-salvage procedures, reconstruction, and potential amputation decisions all depend on which side is affected. Right upper extremity tumors have particular functional significance as most patients are right-hand dominant.

Documentation Requirements

  • ✓Pathology confirming primary bone malignancy with histological type and grade
  • ✓Imaging confirming right-sided location with specific bone identification
  • ✓Explicit right laterality documentation
  • ✓TNM staging and assessment for limb-salvage candidacy
  • ✓Functional assessment of the affected extremity

Commonly Confused Codes

  • •C40.02 — Left upper limb long bones: Verify right laterality from documentation
  • •C40.00 — Unspecified laterality: Use C40.01 when right side is documented
  • •C79.51 — Secondary malignant neoplasm of bone: Confirm primary origin, not metastatic
  • •C40.10-C40.12 — Short bones of upper limb (hand): Long bones are proximal; short bones are in the hand and wrist

Child Codes

C40.00Malignant neoplasm of scapula and long bones of unspecified upper limb
HCC 21
C40.01Malignant neoplasm of scapula and long bones of right upper limb
HCC 21
C40.02Malignant neoplasm of scapula and long bones of left upper limb
HCC 21

Code Hierarchy

└C40Malignant neoplasm of bone and articular cartilage of limbs└C40.0Malignant neoplasm of scapula and long bones of upper limb└C40.01Malignant neoplasm of scapula and long bones of right upper limb
└C40.01Malignant neoplasm of scapula and long bones of right upper limb

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