C67.9
BillableMalignant neoplasm of bladder, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C67.9 an HCC code?
Yes. C67.9 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 C67.9
For C67.9to 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 C67.9 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C67.9 is the ICD-10-CM diagnosis code for malignant neoplasm of bladder, unspecified. Bladder cancer where the specific location within the bladder has not been identified or documented. C67.9 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, C67.9 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, C67.9 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.
This is a default code; query the provider for more specific bladder site information when possible. Because C67.9 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 C67.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a default code; query the provider for more specific bladder site information when possible
- •Review imaging and pathology reports to determine if a more specific C67 code can be assigned
Clinical Significance
This unspecified bladder cancer code indicates a confirmed malignancy where the specific anatomical site within the bladder has not been determined or documented. While it still captures the cancer diagnosis for risk adjustment, it represents a missed opportunity for clinical precision and may signal incomplete documentation that could affect treatment planning.
Documentation Requirements
- ✓Pathology confirming malignant neoplasm of the bladder
- ✓Evidence that more specific site information was sought but unavailable
- ✓Current treatment status and clinical stage
- ✓Histological type and grade from biopsy
- ✓Provider query documented if cystoscopy or imaging is available but site not specified in diagnosis
Commonly Confused Codes
- •C67.0-C67.8 — Specific bladder site codes: always query for specificity before using C67.9; cystoscopy reports almost always identify the site
- •D49.4 — Neoplasm of unspecified behavior, bladder: do not use when malignancy is confirmed
- •Z85.51 — Personal history of bladder cancer: use when cancer is no longer present and patient is in surveillance