ICD-10 C76.3
Billable / Specific HCC v28: 12Malignant neoplasm of pelvis
About ICD-10-CM C76.3
ICD-10-CM code C76.3 represents Malignant neoplasm of pelvis. This is a billable/specific code in the chapter (block C76). The 2026 edition of ICD-10-CM C76.3 became effective on October 1, 2025.
Coding Tips for C76.3
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
C76.3 is a CMS-HCC v28 risk-adjustment code (category 12). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under C76.3. Per CMS ICD-10-CM Tabular 2026.
- Malignant neoplasm of groin NOS
- Malignant neoplasm of sites overlapping systems within the pelvis
- Rectovaginal (septum) malignant neoplasm
- Rectovesical (septum) malignant neoplasm
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Medicare LCD Coverage for C76.3
Local Coverage Determinations (LCDs) from CMS MACs that list C76.3 as a covered diagnosis.
Showing top 10 of 475 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing C76.3.
2 Aetna
5 Medicare
CPT Codes Commonly Billed with C76.3
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 83735 CMS LCD: Billing and Coding: Magnesium CMS LCD
- 45341 CMS LCD: Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic CMS LCD
- 45331 CMS LCD: Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic CMS LCD
- 45337 CMS LCD: Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic CMS LCD
- 45332 CMS LCD: Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic CMS LCD
- 45334 CMS LCD: Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic CMS LCD
- 45335 CMS LCD: Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic CMS LCD
- 45342 CMS LCD: Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic CMS LCD
- 45330 CMS LCD: Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic CMS LCD
- 45338 CMS LCD: Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic CMS LCD
Convert C76.3 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| C76.3 | 1953 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To C76.3
Other codes in section C76-C80 (Malignant neoplasms of ill-defined, other secondary and unspecified sites).
ICD-10 C76.3, Billing FAQ
Is ICD-10 code C76.3 billable? +
Yes, C76.3 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to C76.3? +
ICD-10 C76.3 includes: Malignant neoplasm of groin NOS; Malignant neoplasm of sites overlapping systems within the pelvis; Rectovaginal (septum) malignant neoplasm, and 1 more clinical synonyms.
Does C76.3 affect Medicare Advantage HCC risk adjustment? +
Yes. C76.3 maps to CMS-HCC v28 category 12. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with C76.3? +
Procedures frequently paired with C76.3 include: 83735, 45341, 45331, 45337, 45332.
What ICD-9 codes does C76.3 map to? +
Per CMS GEMs, C76.3 maps to ICD-9 codes: 1953. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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