C69.50
BillableMalignant neoplasm of unspecified lacrimal gland and duct
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C69.50 an HCC code?
Yes. C69.50 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 C69.50
For C69.50 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 C69.50 during that encounter — not just copy-forwarded from a problem list.
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 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, C69.50 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.
Query provider if laterality is documented elsewhere in the record; use specific codes C69.51 or C69.52 when side is known. Because C69.50 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 C69.50 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
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