C76.3
BillableMalignant neoplasm of pelvis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C76.3 an HCC code?
Yes. C76.3 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 C76.3
For C76.3 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 C76.3 during that encounter — not just copy-forwarded from a problem list.
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 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, C76.3 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.
Use this code when pelvic malignancy is confirmed but the specific organ (bladder, prostate, ovary, etc.) is unspecified. Because C76.3 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 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