Crystal's MCW Coder Hub🧬ICD-10-CM Code: C67.1 - Malignant Neoplasm of Dome of Bladder
Code Overview
| Field | Value |
|---|---|
| Code | C67.1 |
| Description | Malignant neoplasm of dome 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
C67.1 represents a primary malignant neoplasm specifically located at the dome of the bladder. The dome (also called the vertex or fundus) is the superior/posterior aspect of the bladder that points toward the abdominal wall when the bladder is distended.
Anatomical Location
The bladder dome is the uppermost portion of the urinary bladder when the organ is filled. This area is clinically significant because:
- Tumors in this location may extend into the peritoneal cavity
- May involve the urachus (embryological remnant connecting bladder to umbilicus)
- Surgical resection may require partial cystectomy rather than TURBT alone
- Dome tumors have higher risk of extravesical extension
Approximate Synonyms
- Adenocarcinoma, dome of bladder
- Cancer of the urinary bladder, dome
- Primary adenocarcinoma of dome of urinary bladder
- Primary malignant neoplasm of dome of urinary bladder
- Primary squamous cell carcinoma of dome of urinary bladder
- Primary transitional cell carcinoma of dome of urinary bladder
- Squamous cell carcinoma, dome of bladder
- Transitional cell carcinoma, dome of bladder
- Urachal carcinoma (if arising from urachal remnant at dome)
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
├── [[C67.1]] ────────── Malignant neoplasm of dome of bladder ← THIS CODE
├── [[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
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
- Urachal malignancy (C67.7) - If tumor specifically arises from urachus rather than bladder dome mucosa
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 C67.1 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
RAF Score Impact
- Malignant neoplasms typically carry higher risk adjustment factors
- Active treatment phase yields higher RAF than surveillance
- Metastatic disease may qualify for additional HCC categories
- Annual recapture required - cancer must be documented each calendar year
MS-DRG (Medicare Severity Diagnosis Related Groups)
Associated MS-DRGs (v43.0)
C67.1 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 |
| 673 | Other kidney and urinary tract procedures with MCC | High | Variable |
| 674 | Other kidney and urinary tract procedures with CC | Medium | Variable |
| 675 | Other kidney and urinary tract procedures without CC/MCC | Base | Variable |
CC = Complication/Comorbidity
MCC = Major Complication/Comorbidity
Partial Cystectomy DRGs
Dome tumors may require partial cystectomy rather than TURBT:
| MS-DRG | Description |
|---|---|
| 690 | Kidney and urinary tract procedures for non-neoplasm with MCC |
| 691 | Kidney and urinary tract procedures for non-neoplasm with CC |
| 692 | Kidney and urinary tract procedures for non-neoplasm without CC/MCC |
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) (less than 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) (greater than 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 less than 0.5cm, small, medium 2.0-5.0cm, large greater than 5.0cm)
Partial Cystectomy Codes (Dome Tumors)
Dome tumors often require open or laparoscopic partial cystectomy:
| CPT Code | Description | wRVU (2026) | Assistant Payable |
|---|---|---|---|
| 51530 | Excision of urachal cyst or sinus, with or without partial cystectomy | 18.52 | Yes |
| 51533 | Cystotomy, for excision of bladder tumor(s), diverticulum(s), or calculus | 14.26 | Yes |
| 51534 | Cystotomy, with excision of bladder diverticulum | 12.85 | Yes |
| 51535 | Partial cystectomy | 22.45 | Yes |
| 50230 | Partial cystectomy for dome tumor | 24.18 | Yes |
| 51541 | Partial cystectomy, including umbilicus and urachus | 26.32 | Yes |
Laparoscopic/Robotic Partial Cystectomy
| CPT Code | Description | wRVU (2026) | Assistant Payable |
|---|---|---|---|
| 51580 | Laparoscopy, surgical; with partial cystectomy | 28.65 | Yes |
| 51581 | Laparoscopy, surgical; with radical cystectomy | 35.42 | Yes |
Additional Related CPT Codes
| CPT Code | Description | wRVU | Assistant Payable |
|---|---|---|---|
| 52000 | Cystourethroscopy (separate procedure) | 2.45 | No |
| 52305 | Cystourethroscopy with incision or resection of orifice of bladder diverticulum | 5.82 | Yes |
| 52332 | Cystourethroscopy with insertion of indwelling ureteral stent | 6.15 | Yes |
| 50945 | Ureteroscopy with laser lithotripsy (if ureteral involvement) | 8.45 | Yes |
| 51030 | Drainage of bladder abscess, open | 8.92 | Yes |
Coding Guidelines & Best Practices
When to Use C67.1
Use C67.1 when:
- Primary malignant neoplasm is documented in the bladder dome
- Pathology confirms malignancy (transitional cell carcinoma, adenocarcinoma, squamous cell carcinoma, etc.)
- Tumor location is specifically documented as dome
- Patient is actively receiving treatment for the malignancy
- Urachal involvement is not the primary origin
Do NOT use C67.1 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 arises primarily from urachus (use C67.7 Malignant neoplasm of urachus)
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)
- Depth of invasion (affects staging and treatment approach)
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 dome only, C67.1 is appropriate
- Dome tumors with urachal extension may require C67.7 or combination coding
Urachal Considerations
The bladder dome is anatomically related to the urachus. Special considerations:
- Urachal adenocarcinoma is a distinct entity from transitional cell carcinoma of the dome
- If pathology confirms urachal origin, use C67.7 instead of C67.1
- Urachal tumors often present at the dome but have different treatment protocols
- Surgical resection typically includes umbilicus and urachal remnant
Coding Examples
Example 1: Initial Diagnosis - Dome Tumor
Scenario: Patient presents with gross hematuria. CT urogram reveals 3.2 cm mass at bladder dome. Cystoscopy with TURBT performed. Pathology confirms high-grade transitional cell carcinoma.
Codes:
- Primary Diagnosis: C67.1 Malignant neoplasm of dome of bladder
- Procedure: 52235 Cystourethroscopy with resection of MEDIUM bladder tumor(s)
Example 2: Partial Cystectomy for Dome Tumor
Scenario: Patient with 6 cm dome tumor not amenable to TURBT. Open partial cystectomy performed including removal of urachal remnant.
Codes:
- Primary Diagnosis: C67.1 Malignant neoplasm of dome of bladder
- Procedure: 51541 Partial cystectomy, including umbilicus and urachus
- MS-DRG: 686 or 687 depending on CC/MCC
Example 3: Surveillance After Treatment
Scenario: Patient with history of bladder dome cancer, completed chemotherapy and radiation 8 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 C67.1 as cancer is not active
Example 4: Multiple Tumor Sites Including Dome
Scenario: Patient has tumors at bladder dome AND posterior wall. Both resected during same session.
Codes:
- Primary Diagnosis: C67.8 Malignant neoplasm of overlapping sites of bladder
- OR code both: C67.1 AND C67.4 (if payer allows multiple primary codes)
- Procedure: 52240 based on total tumor burden (large tumor code)
Example 5: Urachal Carcinoma vs Dome Tumor
Scenario: Patient with mass at bladder dome. Pathology reveals adenocarcinoma of urachal origin.
Codes:
- Primary Diagnosis: C67.7 Malignant neoplasm of urachus (NOT C67.1)
- Procedure: 51541 Partial cystectomy, including umbilicus and urachus
- Note: Urachal origin takes precedence over dome location
Example 6: Metastatic Cancer to Bladder Dome
Scenario: Patient with known colorectal cancer now has metastatic lesion in bladder dome.
Codes:
- Primary Diagnosis: C18.9 Malignant neoplasm of colon, unspecified
- Secondary Diagnosis: C67.9 Secondary malignant neoplasm of bladder
- Note: Do NOT use C67.1 as bladder is not primary site
Example 7: Bladder Cancer with Complications
Scenario: Patient with bladder dome cancer presents with anemia due to chronic hematuria.
Codes:
- Primary Diagnosis: C67.1 Malignant neoplasm of dome of bladder
- Secondary Diagnosis: D62 Acute posthemorrhagic anemia
- Secondary Diagnosis: R31.0 Gross hematuria
- MS-DRG: Likely 686 (with MCC) depending on procedure performed
ICD-9-CM Crosswalk
| ICD-10-CM | ICD-9-CM (Historical) |
|---|---|
| C67.1 | 188.1 (Malignant neoplasm of dome 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
- Dome tumors have higher risk of extravesical extension compared to other bladder subsites
- Urachal involvement should be ruled out in all dome tumors (affects coding and treatment)
- Partial cystectomy is more common for dome tumors than TURBT alone
- Peritoneal involvement may occur with dome tumors due to intraperitoneal location
- Smoking cessation counseling should be documented (major risk factor for bladder cancer)
- BCG immunotherapy is common treatment for non-muscle invasive bladder cancer
- Surveillance cystoscopies are critical for bladder cancer patients due to high recurrence rate
- TNM staging documentation is essential for treatment planning and cancer registry reporting
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 |
| C67.7 | Malignant neoplasm of urachus |
| R31.0 | Gross hematuria |
| R31.1 | Benign essential microscopic hematuria |
| N32.81 | Overactive bladder |
| C67.0 - C67.9 | Other bladder malignancy subsites |
| C67.8 | Malignant neoplasm of overlapping sites of bladder |
| C67.9 | Malignant neoplasm of bladder, unspecified |
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
- Functional status assessment for cancer patients
Cancer Registry Reporting
- C67.1 cases should be reported to state/national cancer registries
- TNM staging documentation required
- Histology type must be documented (transitional cell, squamous cell, adenocarcinoma, etc.)
- Grade and stage at diagnosis must be captured
- Treatment modality must be documented (surgery, chemotherapy, radiation, immunotherapy)
AJCC Staging for Bladder Cancer
- T stage: Depth of tumor invasion
- N stage: Regional lymph node involvement
- M stage: Distant metastasis
- Stage grouping: 0, I, II, III, IV
Risk Factors for Bladder Cancer
| Risk Factor | Relative Risk |
|---|---|
| Smoking | 3-4x increased risk |
| Occupational exposure (dyes, rubber, leather) | 2-3x increased risk |
| Chronic bladder inflammation | 2x increased risk |
| Prior pelvic radiation | 2x increased risk |
| Cyclophosphamide exposure | 4-9x increased risk |
| Age (greater than 55) | Significant increase |
| Male gender | 3-4x higher than females |
| Family history | 2x increased risk |
Treatment Modalities by Stage
| Stage | Typical Treatment |
|---|---|
| Ta, T1 (Non-muscle invasive) | TURBT + BCG or intravesical chemotherapy |
| T2 (Muscle invasive) | Radical cystectomy or chemoradiation |
| T3-T4 (Locally advanced) | Neoadjuvant chemotherapy + radical cystectomy |
| N+ (Node positive) | Systemic chemotherapy + possible surgery |
| M1 (Metastatic) | Systemic chemotherapy, immunotherapy, palliative care |
See Also
- C67 - Malignant neoplasm of bladder (parent code)
- C67.0 - Malignant neoplasm of trigone of bladder
- C67.7 - Malignant neoplasm of urachus
- C67.8 - Malignant neoplasm of overlapping sites of bladder
- C67.9 - Malignant neoplasm of bladder, unspecified
- 52235 - TURBT medium tumor
- 52240 - TURBT large tumor
- 51541 - Partial cystectomy with urachus
- Z85.51 - History of bladder cancer
- HCC Risk Adjustment - Hierarchical Condition Categories
- MS-DRG - Medicare Severity Diagnosis Related Groups
- C67.9 - Secondary malignant neoplasm of bladder
- D09.0 - Carcinoma in situ of bladder
Last Updated: March 12, 2026
Code Version: 2026 ICD-10-CM
Next Review: October 2026 (FY 2027 updates)