What is ICD-10 code C67.6?

C67.6 is the ICD-10-CM diagnosis code for Malignant neoplasm of ureteric orifice. Cancer that develops at the ureteric orifice, the opening where the ureter enters the bladder. It belongs to the ICD-10-CM chapter for neoplasms (c00-d49). C67.6 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. C67.6 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. C67.6 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. C67.6 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does C67.6 map to under V28?

C67.6 maps to CMS-HCC V28 HCC 22 (Bladder, Colorectal, and Other Cancers). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM C67.6: Malignant neoplasm

C67.6 maps to CMS-HCC V28 22. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC Buddy coding tools

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Code lookupC67.6

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

C67.6

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

Malignant neoplasm of ureteric orifice

Cancer that develops at the ureteric orifice, the opening where the ureter enters the bladder.

Buddy Insight

Malignancy at the ureteric orifice is clinically significant because tumors at this location can obstruct urine drainage from the kidney, leading to hydronephrosis and potential renal compromise.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 22

Bladder, Colorectal, and Othe...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 012

HHS-HCC 012 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 11

Colorectal/Bladder/and Other ...

Code-level coefficient reference

RXHCC

Mapped

HCC 22

Prostate, Breast, Bladder, an...

Code-level coefficient reference

Code Book Path

Official

C67Malignant neoplasm of bladder C67.6Malignant neoplasm of ureteric orifice

Inclusion Terms

Official

No inclusion terms are included in this display for C67.6. Check the code and parent instructions in the Code Book.

Excludes 2

Official

No Excludes 2 notes are included in this display for C67.6. Check the code and parent instructions in the Code Book.

Related 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 C67.4Malignant neoplasm of posterior wall of bladder

Includes

Official

No Includes notes are included in this display for C67.6. Check the code and parent instructions in the Code Book.

Excludes 1

Official

No Excludes 1 notes are included in this display for C67.6. Check the code and parent instructions in the Code Book.

Code First

Official

No Code First sequencing instructions are included in this display for C67.6. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for C67.6. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for C67.6. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Pathology-confirmed malignancy specifying ureteric orifice as the site

Cystoscopy findings documenting tumor at the ureteral opening

Imaging (CT urogram or MRI) to evaluate for upper urinary tract extension

Assessment of renal function and any associated hydronephrosis

MEAT Support

HCC Buddy guidance

Pathology-confirmed malignancy specifying ureteric orifice as the site

Cystoscopy findings documenting tumor at the ureteral opening

Imaging (CT urogram or MRI) to evaluate for upper urinary tract extension

Assessment of renal function and any associated hydronephrosis

Audit Caution

HCC Buddy guidance

Confusing ureteric orifice with bladder neck — these are anatomically distinct structures

Failing to evaluate and document upper tract involvement when tumor is at the ureteric orifice

Using C67.9 (unspecified) when cystoscopy clearly identifies the ureteric orifice location

Common Mistakes

HCC Buddy guidance

C67.5 — Bladder neck: the ureteric orifice is where the ureter enters the bladder (upper), while the bladder neck is where urine exits (lower); opposite locations

C66.1/C66.2 — Malignant neoplasm of ureter: if the tumor originates in the distal ureter and extends to the orifice, code the primary ureteral site

C67.8 — Overlapping sites: use when tumor spans the orifice and adjacent bladder wall

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 C67.6 an HCC code?

Yes. C67.6 (Malignant neoplasm of ureteric orifice) maps to HCC 22, Bladder, Colorectal, and Other Cancers under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.363. 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: C67.6 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: C67.6
Description: Malignant neoplasm of ureteric orifice
HCC (V28): HCC 22 — Bladder, Colorectal, and Other Cancers
RAF reference coefficient: 0.363
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 22, Bladder, Colorectal, and Other Cancers

0.363

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 C67.6 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for C67.6

For C67.6, 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

C67.6 is the ICD-10-CM diagnosis code for malignant neoplasm of ureteric orifice. Cancer that develops at the ureteric orifice, the opening where the ureter enters the bladder. C67.6 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, C67.6 maps to Bladder, Colorectal, and Other Cancers (HCC 22) with a source-labeled community, non-dual, aged reference coefficient of 0.363. No V24 mapping is shown for C67.6; 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 distinct from bladder neck (C67.5); verify correct anatomical location in documentation. For C67.6, 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 C67.6 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This is distinct from bladder neck (C67.5); verify correct anatomical location in documentation
•Ureteric orifice involvement may affect kidney drainage and function

Clinical Significance

Malignancy at the ureteric orifice is clinically significant because tumors at this location can obstruct urine drainage from the kidney, leading to hydronephrosis and potential renal compromise. This location requires careful evaluation for upper tract involvement and may necessitate nephroureterectomy in addition to bladder surgery.

Documentation Requirements

✓Pathology-confirmed malignancy specifying ureteric orifice as the site
✓Cystoscopy findings documenting tumor at the ureteral opening
✓Imaging (CT urogram or MRI) to evaluate for upper urinary tract extension
✓Assessment of renal function and any associated hydronephrosis
✓TNM staging information

Commonly Confused Codes

•C67.5: Bladder neck: the ureteric orifice is where the ureter enters the bladder (upper), while the bladder neck is where urine exits (lower); opposite locations
•C66.1/C66.2: Malignant neoplasm of ureter: if the tumor originates in the distal ureter and extends to the orifice, code the primary ureteral site
•C67.8: Overlapping sites: use when tumor spans the orifice and adjacent bladder wall