Is C15.5 a billable ICD-10-CM code?

Yes. C15.5 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does C15.5 sit in the tabular list?

Neoplasms (C00-D49), in the block Malignant neoplasms of digestive organs (C15-C26).

What cannot be coded together with C15.5?

C15.5 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

C15.5

C15.5 — Malignant neoplasm of lower third of esophagus

Billable / specific codeICD-10-CM

C15.5 is a billable, specific ICD-10-CM code for malignant neoplasm of lower third of esophagus. It is valid for submission on a claim.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

malignant neoplasm of cardio-esophageal junction (C16.0)

Risk adjustment

C15.5 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 20 Lung and Other Severe Cancers1.136 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.

Medicare coverage

C15.5 is named in 67 Medicare coverage policies — 67 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A52450Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
A52479Oral Anticancer Drugs - Policy Article
A52479Oral Anticancer Drugs - Policy Article
A52479Oral Anticancer Drugs - Policy Article

Related codes at this level

Codes that share C15. If C15.5 is not quite right, the correct code is usually one of these.

Questions about C15.5

Is C15.5 a billable ICD-10-CM code?: Yes. C15.5 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does C15.5 sit in the tabular list?: Neoplasms (C00-D49), in the block Malignant neoplasms of digestive organs (C15-C26).
What cannot be coded together with C15.5?: C15.5 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.