C69.52 ICD-10-CM Code: Malignant neoplasm of left lacrimal gland and duct
C69.52 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 Buddy coding tools
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FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neoplasms of eye, brain and other parts of central nervous system (C69-C72)
C69.52
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceMalignant neoplasm of left lacrimal gland and duct
A cancerous tumor of the left lacrimal gland or duct, which are structures that produce tears and drain them into the nose.
Buddy Insight
Left lacrimal gland and duct malignancy carries the same clinical urgency as right-sided disease.
CMS-HCC V28
MappedHCC 23
Coefficient HCC 23: 0.186 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 012
Code-level coefficient reference
ESRD/PACE
MappedHCC 12
Code-level coefficient reference
RXHCC
MappedHCC 22
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- Malignant neoplasm of lacrimal sacInherited from C69.5
- Malignant neoplasm of nasolacrimal ductInherited from C69.5
Excludes 2
OfficialNo Excludes 2 notes are included in this display for C69.52. Check the code and parent instructions in the Code Book.
Related Codes
Includes
OfficialNo Includes notes are included in this display for C69.52. 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
OfficialNo Code First sequencing instructions are included in this display for C69.52. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for C69.52. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for C69.52. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 C69.52 an HCC code?
Yes. C69.52 (Malignant neoplasm of left 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: C69.52 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
- C69.52
- Description
- Malignant neoplasm of left 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
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 C69.52 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for C69.52
For C69.52, 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
C69.52 is the ICD-10-CM diagnosis code for malignant neoplasm of left lacrimal gland and duct. A cancerous tumor of the left lacrimal gland or duct, which are structures that produce tears and drain them into the nose. C69.52 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, C69.52 maps to Prostate, Breast, and Other Cancers and Tumors (HCC 23) with a source-labeled community, non-dual, aged reference coefficient of 0.186. No V24 mapping is shown for C69.52; use the applicable model and payment year when reviewing the V28 mapping. 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.
Confirm left side is clearly documented to avoid laterality errors. For C69.52, 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 C69.52 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm left side is clearly documented to avoid laterality errors
- •Document any associated symptoms like dry eye, tearing, or facial swelling related to the tumor
Clinical Significance
Left lacrimal gland and duct malignancy carries the same clinical urgency as right-sided disease. Accurate laterality coding is essential for surgical approach planning and radiation field design. Lacrimal gland cancers often require multimodality treatment including surgery, radiation, and sometimes chemotherapy.
Documentation Requirements
- ✓Pathology confirming malignancy of the lacrimal gland or duct
- ✓Documentation explicitly identifying left side involvement
- ✓Orbital imaging documenting tumor characteristics and extent
- ✓Assessment for bony erosion, perineural spread, and intracranial extension
- ✓Treatment plan and follow-up surveillance schedule
Commonly Confused Codes
- •C69.51: Right lacrimal gland: verify laterality carefully
- •C69.62: Left orbit: use the specific lacrimal gland code rather than general orbital code
- •C69.50: Unspecified lacrimal gland: use C69.52 when left side is documented
- •H04.129: Dry eye related to lacrimal gland dysfunction: benign condition, not malignancy