C16.0 — Malignant neoplasm of cardia
C16.0 is a billable, specific ICD-10-CM code for malignant neoplasm of cardia. It is valid for submission on a claim.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Malignant neoplasm of cardiac orifice
- Malignant neoplasm of cardio-esophageal junction
- Malignant neoplasm of esophagus and stomach
- Malignant neoplasm of gastro-esophageal junction
Other codes that can never be billed with C16.0
These codes carry an Excludes1 note pointing at C16.0. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading C16.0 alone.
- C15.5Malignant neoplasm of lower third of esophagus
Risk adjustment
C16.0 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
C16.0 is named in 70 Medicare coverage policies — 70 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 ™)
- A52450Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
- A52479Oral Anticancer Drugs - Policy Article
- A52479Oral Anticancer Drugs - Policy Article
Related codes at this level
Codes that share C16. If C16.0 is not quite right, the correct code is usually one of these.
- C16.1Malignant neoplasm of fundus of stomach
- C16.2Malignant neoplasm of body of stomach
- C16.3Malignant neoplasm of pyloric antrum
- C16.4Malignant neoplasm of pylorus
- C16.5Malignant neoplasm of lesser curvature of stomach, unspecified
- C16.6Malignant neoplasm of greater curvature of stomach, unspecified
- C16.8Malignant neoplasm of overlapping sites of stomach
- C16.9Malignant neoplasm of stomach, unspecified
Questions about C16.0
- Is C16.0 a billable ICD-10-CM code?
- Yes. C16.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does C16.0 sit in the tabular list?
- Neoplasms (C00-D49), in the block Malignant neoplasms of digestive organs (C15-C26).