C69.00 maps to CMS-HCC V28 23. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupC69.00

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neoplasms of eye, brain and other parts of central nervous system (C69-C72)

C69.00

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

Malignant neoplasm of unspecified conjunctiva

This code represents cancer that has started in the conjunctiva, which is the clear membrane covering the white part of the eye and inner eyelids. The specific location on the conjunctiva has not been specified in the medical record.

Buddy Insight

Conjunctival malignancy, while rare, is significant for risk adjustment because it represents an active ocular surface cancer that can range from squamous cell carcinoma to melanoma or lymphoma.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 23

Prostate, Breast, and Other C...

Coefficient HCC 23: 0.186 (Community Non-Dual Aged (CNA))

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 12

Breast/Prostate/and Other Can...

Code-level coefficient reference

RXHCC

Mapped

HCC 22

Prostate, Breast, Bladder, an...

Code-level coefficient reference

Code Book Path

Official

C69Malignant neoplasm of eye and adnexa C69.0Malignant neoplasm of conjunctiva C69.00Malignant neoplasm of unspecified conjunctiva

Inclusion Terms

Official

No inclusion terms are included in this display for C69.00. Check the code and parent instructions in the Code Book.

Excludes 2

Official

No Excludes 2 notes are included in this display for C69.00. Check the code and parent instructions in the Code Book.

Related Codes

Official

C69.01Malignant neoplasm of right conjunctiva C69.02Malignant neoplasm of left conjunctiva

Includes

Official

No Includes notes are included in this display for C69.00. Check the code and parent instructions in the Code Book.

Excludes 1

Official

malignant neoplasm of connective tissue of eyelid (C49.0)Inherited from C69
malignant neoplasm of eyelid (skin) (C43.1-, C44.1-)Inherited from C69
malignant neoplasm of optic nerve (C72.3-)Inherited from C69

Code First

Official

No Code First sequencing instructions are included in this display for C69.00. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for C69.00. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for C69.00. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Pathology confirming malignancy with histological type (squamous cell carcinoma, melanoma, lymphoma)

Laterality (right, left, or bilateral) — this unspecified code should only be used when laterality is truly unknown

Specific conjunctival location if known (bulbar, palpebral, fornix)

Clinical staging including tumor size and depth of invasion

MEAT Support

HCC Buddy guidance

Pathology confirming malignancy with histological type (squamous cell carcinoma, melanoma, lymphoma)

Laterality (right, left, or bilateral) — this unspecified code should only be used when laterality is truly unknown

Specific conjunctival location if known (bulbar, palpebral, fornix)

Clinical staging including tumor size and depth of invasion

Audit Caution

HCC Buddy guidance

Using the unspecified laterality code when the medical record documents which eye is affected

Confusing conjunctival intraepithelial neoplasia (precancerous) with invasive conjunctival malignancy

Coding eyelid skin cancer as conjunctival cancer — different anatomical structures

Failing to query ophthalmology records that typically specify laterality

Common Mistakes

HCC Buddy guidance

C69.01/C69.02 — Right/left conjunctiva: always use laterality-specific codes when the affected eye is documented

D09.20-D09.22 — Carcinoma in situ of conjunctiva: do not use C69.00 for in situ disease

C44.101-C44.102 — Malignant neoplasm of eyelid skin: conjunctival cancer is mucosal, not skin; verify the tissue of origin

H11.0 — Pterygium: benign conjunctival growth that can be confused with early conjunctival neoplasia

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 C69.00 an HCC code?

Yes. C69.00 (Malignant neoplasm of unspecified conjunctiva) maps to HCC 23, Prostate, Breast, and Other Cancers and Tumors under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.186. 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: C69.00 is billable and maps to V28 HCC 23, Prostate, Breast, and Other Cancers and Tumors. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: C69.00
Description: Malignant neoplasm of unspecified conjunctiva
HCC (V28): HCC 23 — Prostate, Breast, and Other Cancers and Tumors
RAF reference coefficient: 0.186
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 23, Prostate, Breast, and Other Cancers and Tumors

0.186

ESRDHCC 12, Breast/Prostate/and Other Cancers and Tumors

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 C69.00 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for C69.00

For C69.00, 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

Get the V28 mapping + MEAT cheat sheet

One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.

Free PDF. No card. Unsubscribe anytime.

What This Code Means

C69.00 is the ICD-10-CM diagnosis code for malignant neoplasm of unspecified conjunctiva. This code represents cancer that has started in the conjunctiva, which is the clear membrane covering the white part of the eye and inner eyelids. The specific location on the conjunctiva has not been specified in the medical record. C69.00 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering malignant neoplasms of eye, brain and other parts of central nervous system (c69-c72).

Under the CMS-HCC V28 risk adjustment model, C69.00 maps to Prostate, Breast, and Other Cancers and Tumors (HCC 23) with a source-labeled community, non-dual, aged reference coefficient of 0.186. 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.

If the provider documents a specific site of the conjunctival malignancy (such as bulbar, palpebral, or fornix), use the more specific C69.01-C69.09 codes instead of the unspecified code C69.00. For C69.00, 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 C69.00 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•If the provider documents a specific site of the conjunctival malignancy (such as bulbar, palpebral, or fornix), use the more specific C69.01-C69.09 codes instead of the unspecified code C69.00
•This code requires a laterality indicator (right eye, left eye, or bilateral) to be complete; verify documentation specifies which eye(s) are affected and append the appropriate 7th character

Clinical Significance

Conjunctival malignancy, while rare, is significant for risk adjustment because it represents an active ocular surface cancer that can range from squamous cell carcinoma to melanoma or lymphoma. These tumors require specialized ophthalmic oncology management and carry risk of local invasion into the orbit and, in the case of melanoma, systemic metastasis.

Documentation Requirements

✓Pathology confirming malignancy with histological type (squamous cell carcinoma, melanoma, lymphoma)
✓Laterality (right, left, or bilateral) — this unspecified code should only be used when laterality is truly unknown
✓Specific conjunctival location if known (bulbar, palpebral, fornix)
✓Clinical staging including tumor size and depth of invasion
✓Ophthalmologic examination findings

Commonly Confused Codes

•C69.01/C69.02: Right/left conjunctiva: always use laterality-specific codes when the affected eye is documented
•D09.20-D09.22: Carcinoma in situ of conjunctiva: do not use C69.00 for in situ disease
•C44.101-C44.102: Malignant neoplasm of eyelid skin: conjunctival cancer is mucosal, not skin; verify the tissue of origin
•H11.0: Pterygium: benign conjunctival growth that can be confused with early conjunctival neoplasia