C69.22
BillableMalignant neoplasm of left retina
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C69.22 an HCC code?
Yes. C69.22 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 C69.22
For C69.22 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 C69.22 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C69.22 is the ICD-10-CM diagnosis code for malignant neoplasm of left retina. This code describes cancer that has started in the retina, which is the light-sensitive tissue at the back of the left eye. It represents a malignant (cancerous) tumor originating in the retinal cells. C69.22 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, C69.22 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, C69.22 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.
Ensure the documentation specifically identifies the retina as the site of the malignancy and confirms it is the left eye, as laterality (left vs. right) is required for accurate coding. Because C69.22 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 C69.22 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure the documentation specifically identifies the retina as the site of the malignancy and confirms it is the left eye, as laterality (left vs. right) is required for accurate coding
- •Do not use this code for metastatic cancer that has spread to the retina from another site; instead, use codes for secondary neoplasms with the primary site documented separately
Clinical Significance
Left retinal malignancy carries the same diagnostic and therapeutic urgency as right-sided disease. In children with bilateral retinoblastoma, accurate laterality coding for each eye is essential for tracking treatment response and surveillance planning. In adults, retinal melanoma of the left eye requires the same urgent workup for metastatic disease.
Documentation Requirements
- ✓Pathology or clinical findings confirming malignancy
- ✓Explicit documentation of left eye involvement
- ✓Fundoscopic examination findings with tumor characteristics
- ✓Staging and tumor measurement (base diameter, height)
- ✓Treatment modality planned or initiated
Commonly Confused Codes
- •C69.21 — Right retina: verify laterality from clinical documentation
- •C69.32 — Left choroid: confirm the primary tumor layer (retina versus choroid)
- •C69.20 — Unspecified retina: use C69.22 when left eye is documented
- •C79.49 — Secondary neoplasm of nervous system: distinguish primary from metastatic retinal tumors