C26.9: Malignant neoplasm of ill-defined sites within the digestive system
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.
Check C26.9 with the rest of the claim: free scrubberExcludes1: never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
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. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
C26.9 is named in 50 Medicare coverage policies: 50 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- 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®
Code history
Unchanged in every release from FY2024 to FY2027.