C00-C96 — Malignant neoplasms

Risk adjustment in C00-C96

0 codes in this block map to a CMS-HCC, which means the diagnosis carries a risk-adjustment payment when it is documented and coded. Under-coding here is money left on the table; over-coding here is what audits are for.

• HCC 21 Lymphoma and Other Cancers
• HCC 20 Lung and Other Severe Cancers
• HCC 22 Bladder, Colorectal, and Other Cancers
• HCC 23 Prostate, Breast, and Other Cancers and Tumors
• HCC 17 Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic
• HCC 19 Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers

What else to watch in C00-C96

• 214 codes are laterality-specific. They come in left and right pairs, and the pair is mutually exclusive on a single site: coding both without a bilateral code is a contradiction a scrubber should catch before the payer does.
• 1,239 codes are named in Medicare coverage policies. An LCD or NCD lists them as supporting medical necessity, or explicitly as not supporting it. Which applies depends on the MAC for your state.