C69.51
BillableMalignant neoplasm of right lacrimal gland and duct
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C69.51 an HCC code?
Yes. C69.51 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 C69.51
For C69.51 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 C69.51 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C69.51 is the ICD-10-CM diagnosis code for malignant neoplasm of right lacrimal gland and duct. Cancer that starts in the lacrimal gland (tear gland) or its duct on the right side of the eye. This is a malignant tumor that can affect tear production and eye function. C69.51 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, C69.51 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, C69.51 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.
Verify laterality is documented as right (not left or bilateral) before assigning this code; if bilateral, use separate codes for each side. Because C69.51 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 C69.51 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify laterality is documented as right (not left or bilateral) before assigning this code; if bilateral, use separate codes for each side
- •Ensure the diagnosis specifies the lacrimal gland/duct location; if the primary site is unclear or involves other eye structures, review documentation for correct anatomical specificity
Clinical Significance
Right lacrimal gland and duct malignancy requires laterality-specific coding for surgical planning, as treatment often involves lateral orbitotomy with en bloc excision. Adenoid cystic carcinoma of the lacrimal gland is particularly aggressive with a propensity for perineural invasion along cranial nerves, which can lead to intracranial extension.
Documentation Requirements
- ✓Pathology confirming malignancy with histological type
- ✓Documentation confirming right eye/orbit involvement
- ✓Orbital imaging (CT/MRI) documenting tumor extent and any bony erosion
- ✓Assessment for perineural invasion along cranial nerves
- ✓Distinction between lacrimal gland and lacrimal duct involvement
Commonly Confused Codes
- •C69.52 — Left lacrimal gland and duct: verify laterality from clinical documentation
- •C69.61 — Right orbit: use the more specific lacrimal gland code rather than the general orbital code
- •C69.50 — Unspecified lacrimal gland: use C69.51 when right side is documented
- •H04.111 — Dacryops of right lacrimal gland: benign cyst, not malignancy