C76-C80 — Malignant neoplasms of ill-defined, other secondary and unspecified sites
ICD-10-CM codes C76-C80 cover malignant neoplasms of ill-defined, other secondary and unspecified sites, within neoplasms. The block holds 77 codes across 5 categories, of which 59 are billable and 18 are header codes that cannot be submitted on a claim.
Risk adjustment in C76-C80
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 17 Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic
- HCC 18 Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid
- HCC 23 Prostate, Breast, and Other Cancers and Tumors
- HCC 20 Lung and Other Severe Cancers
What else to watch in C76-C80
- 12 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.
- 59 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.