C69-C72 — Malignant neoplasms of eye, brain and other parts of central nervous system
ICD-10-CM codes C69-C72 cover malignant neoplasms of eye, brain and other parts of central nervous system, within neoplasms. The block holds 71 codes across 4 categories, of which 54 are billable and 17 are header codes that cannot be submitted on a claim.
Risk adjustment in C69-C72
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 20 Lung and Other Severe Cancers
- HCC 23 Prostate, Breast, and Other Cancers and Tumors
What else to watch in C69-C72
- 24 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.
- 54 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.