Is C26.9 a billable ICD-10-CM code?

Yes. C26.9 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does C26.9 sit in the tabular list?

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

What cannot be coded together with C26.9?

C26.9 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

C26.9

C26.9 — Malignant neoplasm of ill-defined sites within the digestive system

Billable / specific codeICD-10-CM

C26.9 is a billable, specific ICD-10-CM code for malignant neoplasm of ill-defined sites within the digestive system. 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 abdominal NOS (C76.2)
malignant neoplasm of intra-abdominal NOS (C76.2)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Malignant neoplasm of alimentary canal or tract NOS
Malignant neoplasm of gastrointestinal tract NOS

Risk adjustment

C26.9 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 22 Bladder, Colorectal, and Other Cancers0.363 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

C26.9 is named in 48 Medicare coverage policies — 48 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A52479Oral Anticancer Drugs - Policy Article
A52480Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article
A53101Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID® Update
A54188Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID®

Related codes at this level

Codes that share C26. If C26.9 is not quite right, the correct code is usually one of these.

Questions about C26.9

Is C26.9 a billable ICD-10-CM code?: Yes. C26.9 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does C26.9 sit in the tabular list?: Neoplasms (C00-D49), in the block Malignant neoplasms of digestive organs (C15-C26).
What cannot be coded together with C26.9?: C26.9 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.