2027 ICD-10-CM Diagnosis Code C69.20Malignant neoplasm of unspecified retina
ICD-10-CM Codes›C00–D49›C69-C72›C69
- Billable — Valid for Submission
- Risk Adjusts — HCC 23
- Chronic Condition
C69.20 is a billable ICD-10-CM diagnosis code for malignant neoplasm of unspecified retina. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 124 through 125. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Head and neck cancers - eye.
For Medicare Advantage risk adjustment, C69.20 maps to CMS-HCC Category 23 (Prostate, Breast, and Other Cancers and Tumors) under the V28 model, adding a risk factor of about 0.186 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
C69.20 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Hereditary retinoblastoma
- Malignant neoplasm of retina
- Melanoma-associated retinopathy
- Paraneoplastic retinopathy
- Primary adenocarcinoma of iris neuroepithelium
- Primary malignant neoplasm of retina
- Primary malignant neuroepithelial neoplasm of retina
- Primary retinal pigment epithelial adenocarcinoma
- Primary retinoblastoma of retina
- Retinal pigment epithelial adenocarcinoma
- Retinoblastoma
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to C69.20: its own notes plus those printed at C69.2, C69, and Chapter 2. A note printed at a category, block or chapter applies to every code under it.
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Notes
General instructions on how these codes are used.
- Functional activity
- All neoplasms are classified in this chapter, whether they are functionally active or not. An additional code from Chapter 4 may be used, to identify functional activity associated with any neoplasm.
- Morphology [Histology]
- Chapter 2 classifies neoplasms primarily by site (topography), with broad groupings for behavior, malignant, in situ, benign, etc. The Table of Neoplasms should be used to identify the correct topography code. In a few cases, such as for malignant melanoma and certain neuroendocrine tumors, the morphology (histologic type) is included in the category and codes.
- Primary malignant neoplasms overlapping site boundaries
- A primary malignant neoplasm that overlaps two or more contiguous (next to each other) sites should be classified to the subcategory/code .8 ('overlapping lesion'), unless the combination is specifically indexed elsewhere. For multiple neoplasms of the same site that are not contiguous, such as tumors in different quadrants of the same breast, codes for each site should be assigned.
- Malignant neoplasm of ectopic tissue
- Malignant neoplasms of ectopic tissue are to be coded to the site mentioned, e.g., ectopic pancreatic malignant neoplasms are coded to pancreas, unspecified (C25.9).
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name C69.20, its category, or a range that includes it.
Applicable To 2
These notes mention C69.20.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Malignant Retinal Neoplasm
a primary or metastatic malignant neoplasm that affects the retina.
Table of NeoplasmsClinical
Patient EducationClinical
Eye Cancer
Cancer of the eye is uncommon. It can affect the outer parts of the eye, such as the eyelid, which are made up of muscles, skin and nerves. If the cancer starts inside the eyeball it's called intraocular cancer. The most common intraocular cancers in adults are melanoma and lymphoma.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert C69.20 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About C69.20Overview
What is the ICD-10 code for malignant neoplasm of unspecified retina?
The ICD-10-CM code for malignant neoplasm of unspecified retina is C69.20 (sometimes written as C6920). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is C69.20 (Malignant neoplasm of retina) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report malignant neoplasm of unspecified retina on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does C69.20 group to?
When malignant neoplasm of unspecified retina is the principal diagnosis on an inpatient stay, it groups to MS-DRG 125, 124, with relative weights from 0.7699 to 1.2470 depending on complications. Higher weights mean higher Medicare reimbursement.
Can C69.20 be reported with D49.81?
Not as a rule. The Excludes1 note at C69.2, which applies to C69.20, lists "dark area on retina (D49.81)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What is the ICD-9 equivalent of C69.20?
Under the General Equivalence Mappings, malignant neoplasm of unspecified retina converts to ICD-9-CM 190.5 (malign neopl retina). The mapping is approximate, so confirm the match fits the documentation.
What HCC is C69.20?
C69.20 (malignant neoplasm of unspecified retina) maps to CMS-HCC Category 23 (Prostate, Breast, and Other Cancers and Tumors), commonly written as HCC 23, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 12 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 22.
Does C69.20 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, C69.20 adds a risk adjustment factor of about 0.186 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.186 to 0.237 depending on the payment segment). A more severe related category (HCC 17, HCC 18, HCC 19, HCC 20, HCC 21, and HCC 22) supersedes it when both are reported. See the full factor table on the HCC 23 category page.
