What is ICD-10 code C69.02?

C69.02 is the ICD-10-CM diagnosis code for Malignant neoplasm of left conjunctiva. Cancer of the conjunctiva, the clear membrane covering the white part of the left eye. It belongs to the ICD-10-CM chapter for neoplasms (c00-d49). C69.02 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. C69.02 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. C69.02 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. C69.02 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.

What is the V28 vs V24 difference for C69.02?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For C69.02, V28 maps to Prostate, Breast, and Other Cancers and Tumors at RAF 0.186 while V24 mapped to Breast, Prostate, and Other Cancers and Tumors at RAF 0.150. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting C69.02?

The fifth character specifies laterality; ensure correct eye is documented (right vs. left) Obtain ophthalmology reports confirming conjunctival involvement and histological type Because C69.02 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

2026 ICD-10-CM C69.02: Malignant neoplasm of left

ICD-10-CM Code View

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Code lookupC69.02Effective 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)

C69.02

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

Malignant neoplasm of left conjunctiva

Cancer of the conjunctiva, the clear membrane covering the white part of the left eye.

Buddy Insight

CMS-HCC V28

Mapped

HCC 23

Prostate, Breast, and Other C...

RAF 0.186

CMS-HCC V24

Mapped

HCC 12

Breast, Prostate, and Other C...

RAF 0.150

ACA/HHS

Mapped

HCC 12

HHS-HCC 12

Varies by metal level

ESRD/PACE

Mapped

HCC 12

Breast, Prostate, and Other C...

RAF 0.045

RXHCC

Mapped

HCC 22

Cancer, Other Specified Sites

RAF 0.124

Code Book Path

Official

C69Malignant neoplasm of eye and adnexa

C69.0Malignant neoplasm of conjunctiva

C69.02Malignant neoplasm of left conjunctiva

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for C69.02 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for C69.02 in this effective period.

Related Child Codes

Official

C69.00Malignant neoplasm of unspecified conjunctiva

C69.01Malignant neoplasm of right conjunctiva

Includes

Official

ICD-10-CM does not list Includes notes for C69.02 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for C69.02 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for C69.02 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for C69.02 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for C69.02 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Pathology confirming malignancy with histological type

Explicit documentation of left eye involvement

Detailed description of tumor characteristics including size, location on conjunctiva, and extent

Clinical stage and treatment plan

MEAT Support

HCC Buddy guidance

Pathology confirming malignancy with histological type

Explicit documentation of left eye involvement

Detailed description of tumor characteristics including size, location on conjunctiva, and extent

Clinical stage and treatment plan

Audit Caution

HCC Buddy guidance

Laterality errors when copying from imaging reports that may use reversed orientation

Using unspecified code C69.00 when left eye is documented in the ophthalmology note

Failing to distinguish between primary conjunctival malignancy and secondary involvement from eyelid or orbital tumors

Common Mistakes

HCC Buddy guidance

C69.01 — Right conjunctiva: carefully verify laterality to prevent coding errors

C69.00 — Unspecified conjunctiva: use C69.02 when left eye is clearly documented

C69.12 — Left cornea: conjunctiva and cornea are different ocular structures; verify tissue of origin

C44.122 — Skin cancer of left eyelid: distinguish mucosal conjunctival cancer from skin cancer

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 C69.02 an HCC code?

Yes. C69.02 (Malignant neoplasm of left conjunctiva) maps to Prostate, Breast, and Other Cancers and Tumors under the CMS-HCC V28 risk adjustment model (and Breast, Prostate, and Other Cancers and Tumors under V24), with a community non-dual aged RAF of 0.186. It is billable for payment year 2026.

Coder answer: C69.02 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: C69.02
Description: Malignant neoplasm of left conjunctiva
HCC (V28): HCC 23 — Prostate, Breast, and Other Cancers and Tumors
RAF: 0.186
Billable: Yes
Payment year: 2026

HCC Category Mapping

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

0.186

V24HCC 12, Breast, Prostate, and Other Cancers and Tumors

0.150

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

0.045

RxHCCHCC 22, Cancer, Other Specified Sites

0.124

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work C69.02 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for C69.02

For C69.02 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 C69.02 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

C69.02 is the ICD-10-CM diagnosis code for malignant neoplasm of left conjunctiva. Cancer of the conjunctiva, the clear membrane covering the white part of the left eye. C69.02 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, C69.02 maps to Prostate, Breast, and Other Cancers and Tumors (HCC 23) with a community, non-dual, aged base RAF weight of 0.186. Under the older CMS-HCC V24 model, C69.02 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 C69.02 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 C69.02 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

Left conjunctival malignancy requires the same specialized ophthalmic oncology management as right-sided tumors, with laterality documentation being essential for surgical planning, radiation field targeting, and clinical trial enrollment. The distinction between left and right is not merely administrative but directly impacts treatment delivery.

Documentation Requirements

✓Pathology confirming malignancy with histological type
✓Explicit documentation of left eye involvement
✓Detailed description of tumor characteristics including size, location on conjunctiva, and extent
✓Clinical stage and treatment plan
✓Follow-up surveillance plan for recurrence monitoring

Commonly Confused Codes

•C69.01: Right conjunctiva: carefully verify laterality to prevent coding errors
•C69.00: Unspecified conjunctiva: use C69.02 when left eye is clearly documented
•C69.12: Left cornea: conjunctiva and cornea are different ocular structures; verify tissue of origin
•C44.122: Skin cancer of left eyelid: distinguish mucosal conjunctival cancer from skin cancer