C40.22
BillableMalignant neoplasm of long bones of left lower limb
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C40.22 an HCC code?
Yes. C40.22 maps to Lymphoma and Other Cancers under the CMS-HCC V28 risk adjustment model (and Lymphoma 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 C40.22
For C40.22to 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 C40.22 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C40.22 is the ICD-10-CM diagnosis code for malignant neoplasm of long bones of left lower limb. Cancer that starts in the long bones of the left leg, including the thighbone, shinbone, or smaller bone of the lower leg. C40.22 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, C40.22 maps to Lymphoma and Other Cancers (HCC 21) with a community, non-dual, aged base RAF weight of 0.671. Under the older V24 model, C40.22 mapped to the same category but with a base RAF weight of 0.675 — V28 recalibrated weights across the entire model. 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 left side laterality is clearly documented before assigning this code. Because C40.22 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 C40.22 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify left side laterality is clearly documented before assigning this code
- •Ensure the malignancy involves long bones (femur, tibia, fibula) rather than short bones of the lower limb
Clinical Significance
Primary malignant neoplasm of the long bones (femur, tibia, fibula) of the left lower limb. Long bone cancers of the lower extremity are among the most common primary bone malignancies, with osteosarcoma and Ewing sarcoma predominating in younger patients. Accurate coding with left laterality supports precise surgical planning and risk adjustment.
Documentation Requirements
- ✓Left-side laterality explicitly documented
- ✓Specific long bone involved (femur, tibia, or fibula)
- ✓Histologic confirmation from biopsy or resection specimen
- ✓Primary vs. metastatic origin documented
- ✓Staging and grading information
- ✓Treatment status and response assessment
Commonly Confused Codes
- •C40.21 — Long bones of RIGHT lower limb; opposite laterality
- •C40.20 — Long bones of UNSPECIFIED lower limb; avoid when left is documented
- •C40.32 — Short bones of left lower limb; tarsal/metatarsal bones vs. long bones
- •C79.52 — Secondary malignant neoplasm of bone of left lower limb; for metastatic disease