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C67.4 ICD-10-CM Code: Malignant neoplasm of posterior wall of bladder

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FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neoplasms of urinary tract (C64-C68)

C67.4

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

Malignant neoplasm of posterior wall of bladder

Cancer that develops on the back wall of the bladder, the surface closest to the rectum.

Buddy the Bee presenting code insight

Buddy Insight

Posterior wall bladder cancer is significant for risk adjustment because it represents an active malignancy requiring ongoing surveillance, treatment, and resource utilization.

CMS-HCC V28

HCC 22

RAF 0.363

CMS-HCC V24

HCC 11

RAF 0.307

ACA/HHS

HCC 12

Varies by metal level

ESRD/PACE

HCC 11

RAF 0.059

RXHCC

HCC 22

RAF 0.124

Code Book Path

Official
C67Malignant neoplasm of bladder
C67.4Malignant neoplasm of posterior wall of bladder

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for C67.4 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for C67.4 in this effective period.

Related Child Codes

Official
C67.0Malignant neoplasm of trigone of bladder
C67.1Malignant neoplasm of dome of bladder
C67.2Malignant neoplasm of lateral wall of bladder
C67.3Malignant neoplasm of anterior wall of bladder
C67.5Malignant neoplasm of bladder neck

Includes

Official

ICD-10-CM does not list Includes notes for C67.4 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for C67.4 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for C67.4 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for C67.4 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for C67.4 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Pathology-confirmed malignancy with histological type (transitional cell carcinoma, squamous cell, adenocarcinoma)
Specific anatomical location documented as posterior wall of bladder
Current treatment status (active treatment, surveillance, or history of)
TNM staging or clinical stage documented

MEAT Support

HCC Buddy guidance
Pathology-confirmed malignancy with histological type (transitional cell carcinoma, squamous cell, adenocarcinoma)
Specific anatomical location documented as posterior wall of bladder
Current treatment status (active treatment, surveillance, or history of)
TNM staging or clinical stage documented

Audit Caution

HCC Buddy guidance
Using unspecified C67.9 when operative or cystoscopy report clearly identifies posterior wall location
Coding a history of bladder cancer (Z85.51) when the patient has active disease still under treatment
Failing to distinguish primary bladder cancer from metastatic cancer to the bladder (C79.11)
Not querying the provider when documentation says 'bladder cancer' without specifying the wall or site

Common Mistakes

HCC Buddy guidance
C67.1 — Dome of bladder: posterior wall is the back surface, dome is the top; verify cystoscopy report for exact location
C67.8 — Overlapping sites of bladder: use C67.4 when confined to posterior wall only; use C67.8 when tumor spans multiple distinct bladder regions
C67.9 — Bladder, unspecified: always query for specificity before defaulting to unspecified; posterior wall is commonly identifiable on cystoscopy
C79.11 — Secondary malignant neoplasm of bladder: do not confuse primary bladder cancer with metastatic disease to the bladder

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 C67.4 an HCC code?

Yes. C67.4 (Malignant neoplasm of posterior wall of bladder) maps to Bladder, Colorectal, and Other Cancers under the CMS-HCC V28 risk adjustment model (and Colorectal, Bladder, and Other Cancers under V24), with a community non-dual aged RAF of 0.363. It is billable for payment year 2026.

Coder answer: C67.4 is billable and maps to V28 HCC 22, Bladder, Colorectal, and Other Cancers. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
C67.4
Description
Malignant neoplasm of posterior wall of bladder
HCC (V28)
HCC 22 — Bladder, Colorectal, and Other Cancers
RAF
0.363
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 22, Bladder, Colorectal, and Other Cancers
0.363
V24HCC 11, Colorectal, Bladder, and Other Cancers
0.307
ESRDHCC 11, Colorectal, Bladder, and Other Cancers
0.059
RxHCCHCC 22, Cancer, Other Specified Sites
0.124

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work C67.4 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for C67.4

For C67.4 to 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 C67.4 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

C67.4 is the ICD-10-CM diagnosis code for malignant neoplasm of posterior wall of bladder. Cancer that develops on the back wall of the bladder, the surface closest to the rectum. C67.4 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, C67.4 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, C67.4 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.

Posterior wall location is important for surgical planning and prognosis. Because C67.4 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 C67.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Posterior wall location is important for surgical planning and prognosis
  • •Ensure documentation distinguishes posterior wall from other bladder sites

Clinical Significance

Posterior wall bladder cancer is significant for risk adjustment because it represents an active malignancy requiring ongoing surveillance, treatment, and resource utilization. The posterior wall location is clinically important as it is the most common site for bladder cancer and its proximity to the rectum can complicate surgical resection and staging.

Documentation Requirements

  • ✓Pathology-confirmed malignancy with histological type (transitional cell carcinoma, squamous cell, adenocarcinoma)
  • ✓Specific anatomical location documented as posterior wall of bladder
  • ✓Current treatment status (active treatment, surveillance, or history of)
  • ✓TNM staging or clinical stage documented
  • ✓Cystoscopy or imaging findings confirming site

Commonly Confused Codes

  • •C67.1: Dome of bladder: posterior wall is the back surface, dome is the top; verify cystoscopy report for exact location
  • •C67.8: Overlapping sites of bladder: use C67.4 when confined to posterior wall only; use C67.8 when tumor spans multiple distinct bladder regions
  • •C67.9: Bladder, unspecified: always query for specificity before defaulting to unspecified; posterior wall is commonly identifiable on cystoscopy
  • •C79.11: Secondary malignant neoplasm of bladder: do not confuse primary bladder cancer with metastatic disease to the bladder

Child Codes

C67.0Malignant neoplasm of trigone of bladder
HCC 22
C67.1Malignant neoplasm of dome of bladder
HCC 22
C67.2Malignant neoplasm of lateral wall of bladder
HCC 22
C67.3Malignant neoplasm of anterior wall of bladder
HCC 22
C67.4Malignant neoplasm of posterior wall of bladder
HCC 22
C67.5Malignant neoplasm of bladder neck
HCC 22
C67.6Malignant neoplasm of ureteric orifice
HCC 22
C67.7Malignant neoplasm of urachus
HCC 22
C67.8Malignant neoplasm of overlapping sites of bladder
HCC 22
C67.9Malignant neoplasm of bladder, unspecified
HCC 22

Code Hierarchy

└C67Malignant neoplasm of bladder└C67.4Malignant neoplasm of posterior wall of bladder
└C67.4Malignant neoplasm of posterior wall of bladder

Because C67.4 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

C67.4 maps to CMS-HCC V28 category 22, Bladder, Colorectal, and Other Cancers. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. Because C67.4 carries a payment HCC, you can see what it adds to a RAF score and check the documentation the chart needs before it is submitted.

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