C67.3
BillableMalignant neoplasm of anterior wall of bladder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C67.3 an HCC code?
Yes. C67.3 maps to Bladder, Colorectal, 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 C67.3
For C67.3to 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 C67.3 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C67.3 is the ICD-10-CM diagnosis code for malignant neoplasm of anterior wall of bladder. Cancer that starts on the front wall of the bladder, the surface closest to the abdominal wall. C67.3 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering malignant neoplasms of urinary tract (c64-c68).
Under the CMS-HCC V28 risk adjustment model, C67.3 maps to Bladder, Colorectal, and Other Cancers (HCC 22) with a community, non-dual, aged base RAF weight of 0.363. Under the older CMS-HCC V24 model, C67.3 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.
Anterior wall is clinically distinct from other bladder locations. Because C67.3 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 C67.3 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Anterior wall is clinically distinct from other bladder locations
- •Verify documentation clearly specifies anterior location rather than general bladder cancer
Clinical Significance
Anterior wall bladder cancer involves the front portion of the bladder closest to the pubic symphysis. Tumors in this location may extend into the prevesical space (space of Retzius) and can involve the anterior abdominal wall in advanced cases. This subsite is less common than lateral wall or trigone tumors but is surgically significant because of its relationship to the pubic bone and anterior peritoneum.
Documentation Requirements
- ✓Cystoscopy or imaging confirming anterior wall tumor location
- ✓Histologic type and grade
- ✓Stage — particularly depth of invasion and extension beyond bladder wall
- ✓Whether tumor extends into prevesical fat or anterior abdominal wall
- ✓Treatment plan
- ✓Relationship to urachus (urachal carcinoma is a rare subtype found in this location)
Commonly Confused Codes
- •C67.1 — Dome of bladder; the dome is superior, the anterior wall faces forward toward the pubis
- •C67.2 — Lateral wall; side wall vs. front wall
- •C67.4 — Posterior wall; opposite wall of the bladder
- •C67.9 — Unspecified bladder; use C67.3 when anterior wall is documented
- •C67.7 — Urachus; urachal carcinoma originates from the anterior dome/wall but has its own code