C76.3 ICD-10-CM Code: Malignant neoplasm of pelvis
C76.3 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 ill-defined, other secondary and unspecified sites (C76-C80)
C76.3
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceMalignant neoplasm of pelvis
A malignant (cancerous) tumor located in the pelvic area, but the specific organ or tissue of origin is not further specified.
Buddy Insight
Malignant neoplasm of the pelvis (ill-defined site) represents pelvic cancer where the specific organ of origin cannot be determined.
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 groin NOS
- Malignant neoplasm of sites overlapping systems within the pelvis
- Rectovaginal (septum) malignant neoplasm
- Rectovesical (septum) malignant neoplasm
Excludes 2
OfficialNo Excludes 2 notes are included in this display for C76.3. Check the code and parent instructions in the Code Book.
Related Codes
Includes
OfficialNo Includes notes are included in this display for C76.3. Check the code and parent instructions in the Code Book.
Excludes 1
Official- malignant neoplasm of female genitourinary tract NOS (C57.9)Inherited from C76
- malignant neoplasm of male genitourinary tract NOS (C63.9)Inherited from C76
- malignant neoplasm of lymphoid, hematopoietic and related tissue (C81-C96)Inherited from C76
- malignant neoplasm of skin (C44.-)Inherited from C76
- malignant neoplasm of unspecified site NOS (C80.1)Inherited from C76
Code First
OfficialNo Code First sequencing instructions are included in this display for C76.3. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for C76.3. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for C76.3. 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 C76.3 an HCC code?
Yes. C76.3 (Malignant neoplasm of pelvis) 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: C76.3 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
- C76.3
- Description
- Malignant neoplasm of pelvis
- 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 C76.3 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for C76.3
For C76.3, 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
C76.3 is the ICD-10-CM diagnosis code for malignant neoplasm of pelvis. A malignant (cancerous) tumor located in the pelvic area, but the specific organ or tissue of origin is not further specified. C76.3 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering malignant neoplasms of ill-defined, other secondary and unspecified sites (c76-c80).
Under the CMS-HCC V28 risk adjustment model, C76.3 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.
Use this code when pelvic malignancy is confirmed but the specific organ (bladder, prostate, ovary, etc.) is unspecified. For C76.3, 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 C76.3 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code when pelvic malignancy is confirmed but the specific organ (bladder, prostate, ovary, etc.) is unspecified
- •Attempt to identify the primary site through clinical documentation and imaging to assign a more specific organ-based code
Clinical Significance
Malignant neoplasm of the pelvis (ill-defined site) represents pelvic cancer where the specific organ of origin cannot be determined. Pelvic malignancies of unknown primary may involve overlapping pelvic structures. This code should only be used after thorough workup fails to identify the specific organ of origin.
Documentation Requirements
- ✓Documentation confirming pelvic malignancy without identifiable organ of origin
- ✓Pelvic imaging (CT, MRI pelvis) documenting tumor characteristics and extent
- ✓Pathology with immunohistochemistry to help determine tissue of origin
- ✓Documentation of gynecologic, urologic, and rectal workup as appropriate
- ✓Provider attestation that specific organ of origin cannot be determined
Commonly Confused Codes
- •C56.1-C56.9: Malignant neoplasm of ovary: Common pelvic malignancy with specific code
- •C67.9: Malignant neoplasm of bladder: Bladder cancer has specific codes
- •C53.9/C54.9: Cervical/uterine malignancy: Gynecologic cancers have specific codes
- •C20: Malignant neoplasm of rectum: Rectal cancer has its own code
- •C76.2: Malignant neoplasm of abdomen: Distinguish pelvic from abdominal location