C69.00
BillableMalignant neoplasm of unspecified conjunctiva
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C69.00 an HCC code?
Yes. C69.00 maps to Melanoma and Other Skin Cancers under the CMS-HCC V28 risk adjustment model (and Breast, Prostate, and Other Cancers and Tumors 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 C69.00
For C69.00 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 C69.00 during that encounter — not just copy-forwarded from a problem list.
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 Melanoma and Other Skin Cancers (HCC 23) with a community, non-dual, aged base RAF weight of 0.251. Under the older CMS-HCC V24 model, C69.00 maps to Breast, Prostate, and Other Cancers and Tumors (HCC 12) with a community, non-dual, aged base RAF weight of 0.150. 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.
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. Because C69.00 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 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