Crystal's MCW Coder Hub🧬ICD-10-CM Code: C67.0 - Malignant Neoplasm of Trigone of Bladder
Code Overview
| Field | Value |
|---|---|
| Code | C67.0 |
| Description | Malignant neoplasm of trigone of bladder |
| Code Type | ICD-10-CM Diagnosis Code |
| Status | Billable/Specific |
| Effective Date | October 1, 2025 (2026 Edition) |
| Chapter | C00-D49 (Neoplasms) |
| Category | C64-C68 (Malignant neoplasms of urinary tract) |
| Subcategory | C67 (Malignant neoplasm of bladder) |
Clinical Description
Definition
C67.0 represents a primary malignant neoplasm specifically located at the trigone of the bladder. The trigone is a triangular area at the base of the bladder formed by the two ureteral orifices and the internal urethral orifice.
Anatomical Location
The bladder trigone is a smooth triangular region of the internal urinary bladder formed by the two ureteral orifices and the internal urethral orifice. This area is clinically significant because:
- Tumors in this location may affect ureteral function
- May cause obstructive uropathy
- Often requires careful surgical consideration due to proximity to ureteral openings
Approximate Synonyms
- Adenocarcinoma, trigone of bladder
- Cancer of the urinary bladder, trigone
- Primary adenocarcinoma of trigone of urinary bladder
- Primary malignant neoplasm of trigone of urinary bladder
- Primary squamous cell carcinoma of trigone of urinary bladder
- Primary transitional cell carcinoma of trigone of urinary bladder
- Squamous cell carcinoma, trigone of bladder
- Transitional cell carcinoma, trigone of bladder
ICD-10-CM Code Tree/Hierarchy
C00-D49 ────────────────────────────── Neoplasms
│
└── C64-C68 ──────────────────────── Malignant neoplasms of urinary tract
│
└── [[C67]] ────────────────── Malignant neoplasm of bladder
│
├── [[C67.0]] ────────── Malignant neoplasm of trigone of bladder ← THIS CODE
├── [[C67.1]] ────────── Malignant neoplasm of dome of bladder
├── [[C67.2]] ────────── Malignant neoplasm of lateral wall of bladder
├── [[C67.3]] ────────── Malignant neoplasm of anterior wall of bladder
├── [[C67.4]] ────────── Malignant neoplasm of posterior wall of bladder
├── [[C67.5]] ────────── Malignant neoplasm of bladder neck
├── [[C67.6]] ────────── Malignant neoplasm of ureteric orifice
├── [[C67.7]] ────────── Malignant neoplasm of urachus
├── [[C67.8]] ────────── Malignant neoplasm of overlapping sites of bladder
└── [[C67.9]] ────────── Malignant neoplasm of bladder, unspecified
Note: C67 should not be used for reimbursement purposes as there are multiple codes below it that contain a greater level of detail.
Includes/Excludes Notes
Chapter-Level Notes (C00-D49 Neoplasms)
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 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
- Example: Ectopic pancreatic malignant neoplasms are coded to pancreas, unspecified (C25.9)
Excludes1 Notes
Code also any associated functional activity
Excludes2 Notes
- History of bladder cancer (Z85.51) - Use when patient has completed treatment and is being seen for surveillance only
- Carcinoma in situ of bladder (D09.0) - Non-invasive malignancy
- Secondary/ metastatic cancer to bladder (C67.9) - When bladder is not the primary site
HCC (Hierarchical Condition Category) Risk Adjustment
HCC V28 Model (2026)
| Attribute | Value |
|---|---|
| HCC Model | CMS-HCC V28 (fully phased in by 2026) |
| HCC Category | Solid Organ Malignancies |
| Risk Adjustment | Yes - Malignant neoplasms qualify for HCC risk adjustment |
| Recapture Requirement | Annual documentation required for continued RAF score |
| MEAT Criteria | Monitor, Evaluate, Assess/Address, Treat - must be documented |
HCC V28 Changes Relevant to Oncology
- Payment categories expanded from 86 to 115
- Diagnostic codes decreased from 9,797 to 7,770 codes
- Malignant neoplasm codes generally map to cancer-related HCC categories
- Important: Specific HCC mapping should be verified with current CMS V28 crosswalk files
Documentation Requirements for HCC
For C67.0 to count toward HCC risk adjustment:
- Active cancer status must be clearly documented
- Cancer must be current/active (not history of)
- Provider must address/treat the condition during the encounter
- Documentation must support medical necessity of services provided
MS-DRG (Medicare Severity Diagnosis Related Groups)
Associated MS-DRGs (v43.0)
C67.0 is grouped within the following MS-DRGs when used with applicable procedures:
| MS-DRG | Description | Relative Weight | Approximate Payment* |
|---|---|---|---|
| 656 | Kidney and ureter procedures for neoplasm with MCC | High | $23,168 |
| 657 | Kidney and ureter procedures for neoplasm with CC | Medium | $13,316 |
| 658 | Kidney and ureter procedures for neoplasm without CC/MCC | Base | $11,292 |
| 686 | Kidney and urinary tract neoplasms with MCC | High | Variable |
| 687 | Kidney and urinary tract neoplasms with CC | Medium | Variable |
| 688 | Kidney and urinary tract neoplasms without CC/MCC | Base | Variable |
| 668 | Transurethral procedures with MCC | High | $21,248 |
| 669 | Transurethral procedures with CC | Medium | $11,294 |
| 670 | Transurethral procedures without CC/MCC | Base | $7,112 |
*2026 Medicare unadjusted national average
CC = Complication/Comorbidity
MCC = Major Complication/Comorbidity
Associated CPT Codes for Bladder Tumor Procedures
Transurethral Resection of Bladder Tumor (TURBT) Codes
| CPT Code | Description | wRVU (2026) | Total RVU (Facility) | Total RVU (Office) | Assistant Payable |
|---|---|---|---|---|---|
| 52224 | Cystourethroscopy with fulguration and/or resection of SMALL bladder tumor(s) (< 0.5 cm) | ~5.26 | 5.26 | 22.77 | Yes |
| 52234 | Cystourethroscopy with fulguration and/or resection of SMALL bladder tumor(s) | ~6.49 | 6.49 | N/A | Yes |
| 52235 | Cystourethroscopy with fulguration and/or resection of MEDIUM bladder tumor(s) (2.0 to 5.0 cm) | ~7.62 | 7.62 | N/A | Yes |
| 52240 | Cystourethroscopy with fulguration and/or resection of LARGE bladder tumor(s) (> 5.0 cm) | ~10.30 | 10.30 | N/A | Yes |
| 52204 | Cystourethroscopy with biopsy(s) | ~3.80 | 3.80 | 10.64 | Yes |
| 52214 | Cystourethroscopy with fulguration of trigone, bladder neck, prostatic fossa, urethra | ~4.55 | 4.55 | 21.80 | Yes |
Notes:
- wRVU = work Relative Value Unit
- 2026 Conversion Factor: $33.4009
- “N/A” in office setting indicates Medicare does not deem procedure reimbursable in office setting
- Assistant surgeon payable status: Generally YES for these urological procedures (modifier -80 or -82)
- Tumor size determines code selection (minor <0.5cm, small, medium 2.0-5.0cm, large >5.0cm)
Additional Related CPT Codes
| CPT Code | Description |
|---|---|
| 52000 | Cystourethroscopy (separate procedure) |
| 52305 | Cystourethroscopy with incision or resection of orifice of bladder diverticulum |
| 52332 | Cystourethroscopy with insertion of indwelling ureteral stent |
| 50945 | Ureteroscopy with laser lithotripsy (if ureteral involvement) |
Coding Guidelines & Best Practices
When to Use C67.0
✅ Use C67.0 when:
- Primary malignant neoplasm is documented in the bladder trigone
- Pathology confirms malignancy (transitional cell carcinoma, adenocarcinoma, squamous cell carcinoma, etc.)
- Tumor location is specifically documented as trigone
- Patient is actively receiving treatment for the malignancy
❌ Do NOT use C67.0 when:
- Cancer is in remission and patient is only under surveillance (use Z85.51 History of bladder cancer)
- Tumor is carcinoma in situ (use D09.0)
- Bladder is secondary/metastatic site (use C67.9 Secondary malignant neoplasm of bladder)
- Location is not specified (use C67.9 Malignant neoplasm of bladder, unspecified)
- Tumor is benign (use D30.3 Benign neoplasm of bladder)
Tumor Size Documentation
For accurate CPT coding, the following must be documented:
- Number of tumors resected
- Size of each tumor (determines 52224, 52234, 52235, or 52240)
- Location of tumors within bladder
- Method of resection/fulguration (electrocautery, laser, cryosurgery)
Multiple Tumors
- If tumors are in different subsites of the bladder, code each location separately
- If tumors overlap contiguous sites, use C67.8 (overlapping sites of bladder)
- If multiple tumors are in the trigone only, C67.0 is appropriate
Coding Examples
Example 1: Initial Diagnosis
Scenario: Patient presents with hematuria. Cystoscopy reveals 2.5 cm tumor at bladder trigone. TURBT performed. Pathology confirms transitional cell carcinoma.
Codes:
- Primary Diagnosis: C67.0 Malignant neoplasm of trigone of bladder
- Procedure: 52235 Cystourethroscopy with resection of MEDIUM bladder tumor(s)
Example 2: Surveillance After Treatment
Scenario: Patient with history of bladder trigone cancer, completed BCG therapy 6 months ago. Now presents for routine surveillance cystoscopy. No tumor found.
Codes:
- Primary Diagnosis: Z85.51 Personal history of malignant neoplasm of bladder
- Procedure: 52000 Cystourethroscopy (separate procedure)
- Note: Do NOT use C67.0 as cancer is not active
Example 3: Multiple Tumor Sites
Scenario: Patient has tumors at bladder trigone AND lateral wall. Both resected during same session.
Codes:
- Primary Diagnosis: C67.8 Malignant neoplasm of overlapping sites of bladder
- OR code both: C67.0 AND C67.2 (if payer allows multiple primary codes)
- Procedure: 52235 or 52240 based on total tumor burden
Example 4: Metastatic Cancer to Bladder
Scenario: Patient with known lung cancer now has metastatic lesion in bladder trigone.
Codes:
- Primary Diagnosis: C34.90 Malignant neoplasm of unspecified part of bronchus or lung
- Secondary Diagnosis: C67.9 Secondary malignant neoplasm of bladder
- Note: Do NOT use C67.0 as bladder is not primary site
Example 5: Bladder Cancer with Complications
Scenario: Patient with bladder trigone cancer presents with hydronephrosis due to ureteral obstruction from tumor.
Codes:
- Primary Diagnosis: C67.0 Malignant neoplasm of trigone of bladder
- Secondary Diagnosis: N13.4 Hydronephrosis with ureteral stricture, not elsewhere classified
- MS-DRG: Likely 656 or 686 (with MCC) depending on procedure performed
ICD-9-CM Crosswalk
| ICD-10-CM | ICD-9-CM (Historical) |
|---|---|
| C67.0 | 188.0 (Malignant neoplasm of trigone of bladder) |
Note: ICD-9-CM codes were retired October 1, 2015. All claims with date of service on or after October 1, 2015 require ICD-10-CM codes.
Code History
| Year | Effective Date | Change |
|---|---|---|
| 2016 | 10/01/2015 | New code (first year of non-draft ICD-10-CM) |
| 2017-2026 | 10/01 annually | No change to code descriptor |
Clinical Pearls
- Trigone tumors may require more complex surgical approach due to proximity to ureteral orifices
- Ureteral stenting (52332) may be necessary if tumor obstructs ureteral opening
- BCG immunotherapy is common treatment for non-muscle invasive bladder cancer
- Surveillance cystoscopies are critical for bladder cancer patients due to high recurrence rate
- Smoking cessation counseling should be documented (major risk factor for bladder cancer)
Related Codes to Consider
| Code | Description |
|---|---|
| Z85.51 | Personal history of malignant neoplasm of bladder |
| D09.0 | Carcinoma in situ of bladder |
| C67.9 | Secondary malignant neoplasm of bladder |
| D30.3 | Benign neoplasm of bladder |
| R31.0 | Gross hematuria |
| R31.1 | Benign essential microscopic hematuria |
| N32.81 | Overactive bladder |
| C67.1 - C67.9 | Other bladder malignancy subsites |
Quality Measures & Reporting
MIPS/QPP Considerations
- Cancer treatment may qualify for Oncology specialty measures
- Pain assessment and follow-up may be required
- Smoking cessation intervention documentation
- Advance care planning for advanced malignancies
Cancer Registry Reporting
- C67.0 cases should be reported to state/national cancer registries
- TNM staging documentation required
- Histology type must be documented (transitional cell, squamous cell, adenocarcinoma, etc.)
References & Resources
- CMS ICD-10-CM Official Guidelines for Coding and Reporting
- Medicare Physician Fee Schedule 2026
- CMS-HCC V28 Risk Adjustment Model
- AJCC Cancer Staging Manual (Bladder)
- NCCN Guidelines for Bladder Cancer
See Also
- C67 - Malignant neoplasm of bladder (parent code)
- C67.1 - Malignant neoplasm of dome of bladder
- C67.9 - Malignant neoplasm of bladder, unspecified
- 52235 - TURBT medium tumor
- 52240 - TURBT large tumor
- Z85.51 - History of bladder cancer
- HCC Risk Adjustment - Hierarchical Condition Categories
- MS-DRG - Medicare Severity Diagnosis Related Groups
Last Updated: March 12, 2026
Code Version: 2026 ICD-10-CM
Next Review: October 2026 (FY 2027 updates)