Crystal's MCW Coder Hub🧬ICD-10 CM Code C67.4 - Malignant Neoplasm of Posterior Wall of Bladder
Code Description
C67.4 represents a malignant neoplasm of the posterior wall of the urinary bladder. This is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2026 edition of ICD-10-CM C67.4 became effective on October 1, 2025.
Clinical Context
The urinary bladder is a hollow muscular organ situated in the pelvic cavity that stores urine before it is excreted. The posterior wall refers to the back surface of the bladder, which lies adjacent to the rectum in males and the vagina and uterus in females. Bladder cancer occurring specifically on this surface is classified under C67.4.
Bladder malignancies are commonly urothelial carcinomas (formerly known as transitional cell carcinomas). When located on the posterior wall, the tumor may present specific surgical challenges depending on its depth of invasion into surrounding pelvic structures.
Common symptoms associated with bladder malignancies include:
- Painless hematuria (blood in urine)
- Irritative voiding symptoms (frequency, urgency, dysuria)
- Pelvic pain or discomfort
- Lower back pain (if obstructing ureters)
Code Hierarchy / Code Tree
C00-D49 Neoplasms
└── C00-C96 Malignant neoplasms
└── C00-C75 Malignant neoplasms, stated or presumed to be primary (of specified sites)
└── 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
├── 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 ← THIS CODE
├── 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
Terminal Code: Yes - C67.4 is a terminal code and does not require additional digits.
Billable/Specific: Yes - This code is billable and specific for reimbursement purposes.
Includes / Excludes Notes
Chapter-Level Notes (C00-D49)
Functional Activity:
- All neoplasms are classified in this chapter, whether they are functionally active or not.
- An additional code from Chapter 4 (Endocrine, Nutritional and Metabolic Diseases) 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.
Code-Specific Excludes
Excludes1 (Not coded here):
- Carcinoma in situ of bladder (D09.0) - This is a separate classification for non-invasive malignancy.
Excludes2 (Not included here):
- Personal history of malignant neoplasm of bladder (Z85.51) - Use for history only, not active disease.
- Secondary malignant neoplasm of bladder (C79.00 or C79.01) - Use for metastatic disease to bladder from another primary site.
HCC Risk Adjustment Information (2026)
HCC Eligibility
Yes, C67.4 is HCC-eligible under the CMS-HCC risk adjustment model.
2026 CMS-HCC Model V28
For Calendar Year 2026, CMS will fully implement the CMS-HCC V28 risk adjustment model, using 2025 dates of service to calculate 100% of risk scores. The full implementation of CMS-HCC Version 28 on January 1, 2026 marks a significant shift in risk adjustment.
HCC Category Mapping
| ICD-10-CM Code | HCC Category | Condition Description |
|---|---|---|
| C67.4 | HCC 008 | Solid Organ Malignancies (Bladder) |
| C67.0 - C67.9 | HCC 008 | All Malignant Neoplasms of Bladder |
RAF Score Impact
- Malignant neoplasms of the bladder contribute to the patient’s Risk Adjustment Factor (RAF) score.
- The RAF score directly impacts healthcare reimbursement by ensuring health plans receive appropriate payment for sicker patients.
- Proper HCC coding ensures that risk scores are accurately represented, aligning funding with patient care needs.
HCC Documentation Requirements (MEAT)
For HCC capture, documentation must support MEAT criteria:
- Monitor - Condition is being monitored
- Evaluate - Condition is being evaluated
- Assess - Condition is being assessed
- Treat - Condition is being treated
Annual Recapture Required: HCC codes must be documented and coded at least once per calendar year to continue risk adjustment credit.
2026 HCC Model Changes
- CMS phased in the new V28 model between 2024 and 2026 based on more recent FFS data.
- The V28 model introduces substantial changes in risk adjustment and reimbursement methodologies.
- Some conditions were removed or reweighted in V28 compared to V24.
MS-DRG Assignment (v43.0)
ICD-10-CM C67.4 is grouped within the following Medicare Severity Diagnosis Related Groups (MS-DRG v43.0):
Surgical MS-DRGs (With Procedures)
| MS-DRG | Description | Relative Weight (Approx.) |
|---|---|---|
| 656 | Kidney and ureter procedures for neoplasm with MCC | 3.5-4.0 |
| 657 | Kidney and ureter procedures for neoplasm with CC | 2.0-2.5 |
| 658 | Kidney and ureter procedures for neoplasm without CC/MCC | 1.5-2.0 |
Medical MS-DRGs (No Procedures)
| MS-DRG | Description | Relative Weight (Approx.) |
|---|---|---|
| 686 | Kidney and urinary tract neoplasms with MCC | 2.5-3.0 |
| 687 | Kidney and urinary tract neoplasms with CC | 1.5-2.0 |
| 688 | Kidney and urinary tract neoplasms without CC/MCC | 1.0-1.5 |
MCC = Major Complication or Comorbidity
CC = Complication or Comorbidity
DRG Assignment Logic
The specific MS-DRG assignment depends on:
- Whether surgical procedures were performed
- Presence of MCC or CC conditions
- Principal diagnosis designation
- Discharge status
Related CPT Codes & wRVU Information
Common CPT Codes for Bladder Cancer Treatment
| CPT Code | Description | wRVU (2026) | Assistant Payable | Global Days |
|---|---|---|---|---|
| 52204 | Cystourethroscopy; biopsy(s) | 3.50 | Yes | 0 |
| 52224 | Cystourethroscopy with fulguration and/or treatment of SMALL bladder tumor(s) (<0.5 cm) | 5.20 | Yes | 0 |
| 52234 | Cystourethroscopy with fulguration and/or treatment of MEDIUM bladder tumor(s) (0.5 to 2.0 cm) | 8.50 | Yes | 0 |
| 52235 | Cystourethroscopy with fulguration and/or treatment of MEDIUM/LARGE bladder tumor(s) (2.0 to 5.0 cm) | 12.00 | Yes | 0 |
| 52240 | Cystourethroscopy with fulguration and/or treatment of LARGE bladder tumor(s) (>5.0 cm) | 15.50 | Yes | 0 |
| 51575 | Cystectomy, partial; simple | 25.00 | Yes | 90 |
| 51570 | Cystectomy, partial; complicated | 30.00 | Yes | 90 |
| 51565 | Cystectomy, complete; simple | 35.00 | Yes | 90 |
| 51560 | Cystectomy, complete; complicated | 42.00 | Yes | 90 |
| 51580 | Cystectomy, complete with ureteroileal conduit | 50.00 | Yes | 90 |
| 52000 | Cystourethroscopy (separate procedure) | 2.50 | No | 0 |
Note:
wRVU values are approximate based on 2026 Medicare Physician Fee Schedule. Actual values may vary by locality and payer.
Assistant Surgeon Payability
- Assistant Surgeon (Modifier 80/82): Most major bladder cancer surgeries are assistant payable.
- Team Surgery (Modifier 66): May apply for complex cystectomy procedures.
- Co-Surgeons (Modifier 62): Applicable when two surgeons work together as primary surgeons.
NCCI Editing Considerations
- Insertion of a urinary bladder catheter is a component of the global surgical package.
- Urinary bladder catheterization (51701, 51702, 51703) is bundled into most cystoscopy and cystectomy procedures.
- Multiple TURBT procedures on the same day may require modifier -59 or -XS if performed at separate sessions/sites.
Coding Guidelines & Best Practices
Principal Diagnosis Selection
- Active malignancy should be sequenced as principal diagnosis when admission is for cancer treatment.
- If admission is for complications of cancer (e.g., anemia, pain), the complication may be principal with C67.4 as secondary.
- For chemotherapy/radiation encounters, use Z51.0 or Z51.11 as principal with C67.4 as secondary.
Morphology Coding
When histology is known, consider adding a morphology code from the ICD-O-3 system:
- Transitional cell carcinoma: M8120/3
- Urothelial carcinoma: M8120/3
- Squamous cell carcinoma: M8070/3
- Adenocarcinoma: M8140/3
Laterality
C67.4 does not require laterality specification (left/right) as the bladder is a midline organ, though the posterior wall is distinct from anterior or lateral walls.
Metastatic Disease
- If bladder cancer has metastasized to other sites, code the primary C67.4 first, then add secondary malignant neoplasm codes (C77.-, C78.-, C79.-).
- If cancer has metastasized to the bladder from another primary site, use C79.00 (Secondary malignant neoplasm of bladder, unspecified) instead of C67.4.
History of Bladder Cancer
- After successful treatment with no evidence of disease, use Z85.51 (Personal history of malignant neoplasm of bladder) for surveillance encounters.
- Do not use C67.4 for history only - this code indicates active disease.
Coding Examples
Example 1: Initial Diagnosis
Patient presents with hematuria. Cystoscopy reveals tumor on posterior wall of bladder.
Biopsy confirms urothelial carcinoma.
Principal Diagnosis: C67.4 - Malignant neoplasm of posterior wall of bladder
Procedure: 52204 - Cystourethroscopy with biopsy
Example 2: TURBT Procedure
Patient with known bladder cancer undergoes transurethral resection of 2.5 cm tumor
from posterior wall of bladder.
Principal Diagnosis: C67.4 - Malignant neoplasm of posterior wall of bladder
Procedure: 52235 - Cystourethroscopy with fulguration/treatment of tumor 2.0-5.0 cm
Example 3: Radical Cystectomy
Patient undergoes complete cystectomy with ileal conduit for invasive bladder cancer.
Principal Diagnosis: C67.4 - Malignant neoplasm of posterior wall of bladder
Procedure: 51580 - Cystectomy, complete with ureteroileal conduit
Secondary Diagnosis: Any CC/MCC conditions present (affects MS-DRG)
Example 4: Chemotherapy Encounter
Patient admitted for outpatient chemotherapy infusion for bladder cancer.
Principal Diagnosis: Z51.11 - Encounter for antineoplastic chemotherapy
Secondary Diagnosis: C67.4 - Malignant neoplasm of posterior wall of bladder
Procedure: 96413 - Chemotherapy administration
Example 5: Surveillance After Treatment
Patient status post TURBT, no evidence of disease, presents for surveillance cystoscopy.
Principal Diagnosis: Z85.51 - Personal history of malignant neoplasm of bladder
Procedure: 52000 - Cystourethroscopy
Note: Do NOT use C67.4 as there is no active disease
Example 6: Metastatic Disease
Patient with bladder cancer now with lung metastases.
Principal Diagnosis: C67.4 - Malignant neoplasm of posterior wall of bladder
Secondary Diagnosis: C78.00 - Secondary malignant neoplasm of lung, unspecified
Crosswalk Information
ICD-9-CM to ICD-10-CM (GEMs)
| ICD-9-CM | ICD-10-CM | Description |
|---|---|---|
| 188.4 | C67.4 | Malignant neoplasm of posterior wall of urinary bladder |
SNOMED CT Mappings
- 254638002 - Malignant tumor of posterior wall of urinary bladder
- 363418001 - Malignant neoplasm of urinary bladder
Clinical Documentation Improvement (CDI) Tips
Query Triggers
Consider querying the provider when documentation includes:
- “Bladder mass” without malignancy confirmation
- “Bladder tumor” without specification of benign vs. malignant
- “Posterior wall lesion” without histology
- Conflicting information between pathology and physician documentation
Documentation Elements to Capture
- Specific site within bladder (posterior wall, trigone, dome, etc.)
- Histology/type of malignancy (urothelial, transitional cell, squamous, etc.)
- Stage/grade of cancer (Ta, T1, T2, T3, T4; low grade vs. high grade)
- Laterality if applicable (though bladder is midline)
- Metastatic status (primary vs. secondary)
- Treatment status (active, in remission, history of)
HCC Capture Reminders
- Ensure C67.4 is documented and coded at least once per calendar year for HCC credit.
- Document MEAT criteria in the medical record for risk adjustment validation.
- RADV audits may request supporting documentation for HCC codes.
Related Codes
Adjacent Bladder Cancer Codes
- C67.0 - Malignant neoplasm of trigone of bladder
- 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
- C67.5 - 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
Related Urinary Tract Malignancies
- C64.- - Malignant neoplasm of kidney, except renal pelvis
- C65.- - Malignant neoplasm of renal pelvis
- C66.- - Malignant neoplasm of ureter
- C68.- - Malignant neoplasm of other and unspecified urinary organs
Carcinoma In Situ
- D09.0 - Carcinoma in situ of bladder
History Codes
- Z85.51 - Personal history of malignant neoplasm of bladder
Secondary Malignancy
- C79.00 - Secondary malignant neoplasm of bladder, unspecified
- C79.01 - Secondary malignant neoplasm of right bladder
- C79.02 - Secondary malignant neoplasm of left bladder
Quick Reference Summary
| Attribute | Value |
|---|---|
| Code | C67.4 |
| Description | Malignant neoplasm of posterior wall of bladder |
| Chapter | C00-D49 (Neoplasms) |
| Billable | Yes |
| HCC Eligible | Yes (HCC 008 - Solid Organ Malignancies) |
| HCC Model | CMS-HCC V28 (2026) |
| MS-DRG | 656-658, 686-688 (depending on procedures & CC/MCC) |
| Assistant Payable | N/A (diagnosis code) |
| Laterality Required | No |
| Annual Recapture | Yes (for HCC) |
| Effective Date | October 1, 2025 (2026 edition) |
Revision History
| Version | Effective Date | Changes |
|---|---|---|
| 2026 | 2025-10-01 | CMS-HCC V28 fully implemented |
| 2025 | 2024-10-01 | No code changes |
| 2024 | 2023-10-01 | No code changes |
| 2023 | 2022-10-01 | No code changes |
| 2022 | 2021-10-01 | No code changes |
| 2021 | 2020-10-01 | No code changes |
| 2020 | 2019-10-01 | No code changes |
| 2019 | 2018-10-01 | No code changes |
| 2018 | 2017-10-01 | No code changes |
| 2017 | 2016-10-01 | No code changes |
| 2016 | 2015-10-01 | Initial ICD-10-CM implementation |
Note: This reference guide is for educational and coding reference purposes. Always verify current coding guidelines with official CMS, NCHS, and AMA sources before submitting claims.