C69.50 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 · HCC coding software

ICD-10-CM Code View

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Code lookupC69.50

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)

C69.50

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

Malignant neoplasm of unspecified lacrimal gland and duct

A cancerous tumor of the lacrimal gland or duct (structures that produce and drain tears) when the specific side is not documented.

Buddy Insight

Lacrimal gland malignancy is uncommon and encompasses several histological types including adenoid cystic carcinoma (most common malignant type), adenocarcinoma, and 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 C69.5Malignant neoplasm of lacrimal gland and duct C69.50Malignant neoplasm of unspecified lacrimal gland and duct

Inclusion Terms

Official

Malignant neoplasm of lacrimal sacInherited from C69.5
Malignant neoplasm of nasolacrimal ductInherited from C69.5

Excludes 2

Official

No Excludes 2 notes are included in this display for C69.50. Check the code and parent instructions in the Code Book.

Related Codes

Official

C69.51Malignant neoplasm of right lacrimal gland and duct C69.52Malignant neoplasm of left lacrimal gland and duct

Includes

Official

No Includes notes are included in this display for C69.50. 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 C69.50. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for C69.50. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for C69.50. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Pathology confirming malignancy with specific histological type

Laterality — query required for this unspecified code

Imaging (CT or MRI orbit) showing lacrimal gland mass with characteristics

Assessment for orbital invasion, bone involvement, and perineural spread

MEAT Support

HCC Buddy guidance

Pathology confirming malignancy with specific histological type

Laterality — query required for this unspecified code

Imaging (CT or MRI orbit) showing lacrimal gland mass with characteristics

Assessment for orbital invasion, bone involvement, and perineural spread

Audit Caution

HCC Buddy guidance

Using unspecified laterality when the affected eye is documented in imaging reports

Coding benign lacrimal gland pleomorphic adenoma as malignant

Misclassifying lacrimal gland lymphoma under lymphoma codes rather than the site-specific lacrimal code

Confusing lacrimal gland tumors with dacryocystitis or other inflammatory conditions

Common Mistakes

HCC Buddy guidance

C69.51/C69.52 — Right/left lacrimal gland: always use laterality-specific codes when the side is known

C69.60-C69.62 — Orbital malignancy: lacrimal gland is within the orbit but has a specific code; do not use the general orbital code

D31.50-D31.52 — Benign neoplasm of lacrimal gland: distinguish benign pleomorphic adenoma from malignancy

C09.0-C09.9 — Tonsil/salivary gland cancers: lacrimal gland tumors share histology with salivary gland tumors but require different codes

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 C69.50 an HCC code?

Yes. C69.50 (Malignant neoplasm of unspecified lacrimal gland and duct) 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: C69.50 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: C69.50
Description: Malignant neoplasm of unspecified lacrimal gland and duct
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 C69.50 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for C69.50

For C69.50, 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

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What This Code Means

C69.50 is the ICD-10-CM diagnosis code for malignant neoplasm of unspecified lacrimal gland and duct. A cancerous tumor of the lacrimal gland or duct (structures that produce and drain tears) when the specific side is not documented. C69.50 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, C69.50 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.

Query provider if laterality is documented elsewhere in the record; use specific codes C69.51 or C69.52 when side is known. For C69.50, 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 C69.50 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Query provider if laterality is documented elsewhere in the record; use specific codes C69.51 or C69.52 when side is known
•Lacrimal gland malignancies are often adenocarcinomas; verify histological type from pathology

Clinical Significance

Lacrimal gland malignancy is uncommon and encompasses several histological types including adenoid cystic carcinoma (most common malignant type), adenocarcinoma, and lymphoma. These tumors present as orbital masses with proptosis and can be aggressive, with adenoid cystic carcinoma known for perineural invasion and late recurrence requiring long-term surveillance.

Documentation Requirements

✓Pathology confirming malignancy with specific histological type
✓Laterality — query required for this unspecified code
✓Imaging (CT or MRI orbit) showing lacrimal gland mass with characteristics
✓Assessment for orbital invasion, bone involvement, and perineural spread
✓Clinical staging and treatment plan

Commonly Confused Codes

•C69.51/C69.52: Right/left lacrimal gland: always use laterality-specific codes when the side is known
•C69.60-C69.62: Orbital malignancy: lacrimal gland is within the orbit but has a specific code; do not use the general orbital code
•D31.50-D31.52: Benign neoplasm of lacrimal gland: distinguish benign pleomorphic adenoma from malignancy
•C09.0-C09.9: Tonsil/salivary gland cancers: lacrimal gland tumors share histology with salivary gland tumors but require different codes