C69.01 ICD-10-CM Code: Malignant neoplasm of right conjunctiva
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neoplasms of eye, brain and other parts of central nervous system (C69-C72)
C69.01
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceMalignant neoplasm of right conjunctiva
Cancer of the conjunctiva, the clear membrane covering the white part of the right eye.
Buddy Insight
Right conjunctival malignancy requires laterality-specific coding for accurate clinical tracking and treatment planning.
CMS-HCC V28
MappedHCC 23
RAF 0.251
CMS-HCC V24
MappedHCC 12
RAF 0.150
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 12
RAF 0.0
RXHCC
MappedHCC 22
RAF 0.0
Code Trumping
Basket needed
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for C69.01 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for C69.01 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for C69.01 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for C69.01 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for C69.01 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for C69.01 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for C69.01 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is C69.01 an HCC code?
Yes. C69.01 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 C69.01
For C69.01to 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 C69.01 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
C69.01 is the ICD-10-CM diagnosis code for malignant neoplasm of right conjunctiva. Cancer of the conjunctiva, the clear membrane covering the white part of the right eye. C69.01 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, C69.01 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, C69.01 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.
The fifth character specifies laterality; ensure correct eye is documented (right vs. left). Because C69.01 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 C69.01 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •The fifth character specifies laterality; ensure correct eye is documented (right vs. left)
- •Obtain ophthalmology reports confirming conjunctival involvement and histological type
Clinical Significance
Right conjunctival malignancy requires laterality-specific coding for accurate clinical tracking and treatment planning. Conjunctival cancers, though uncommon, can be vision-threatening and may indicate systemic conditions such as immunosuppression (especially with squamous cell carcinoma related to human immunodeficiency virus) or genetic predisposition.
Documentation Requirements
- ✓Pathology confirming malignancy with specific histological type
- ✓Documentation clearly stating right eye involvement
- ✓Ophthalmologic examination with detailed description of tumor location on the conjunctiva
- ✓Tumor dimensions, depth of invasion, and clinical stage
- ✓Any associated conditions (human immunodeficiency virus status, immunosuppression)
Commonly Confused Codes
- •C69.02 — Left conjunctiva: verify laterality carefully; documentation sometimes references the image side rather than patient side
- •C69.00 — Unspecified conjunctiva: use C69.01 when right eye is documented
- •C69.11 — Right cornea: conjunctiva covers the white of the eye; cornea is the clear front surface — different structures
- •D09.21 — Carcinoma in situ of right conjunctiva: invasive versus in situ distinction is critical