C7A.011
BillableMalignant carcinoid tumor of the jejunum
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C7A.011 an HCC code?
Yes. C7A.011 maps to Lymphoma and Other Cancers under the CMS-HCC V28 risk adjustment model (and Breast, Prostate, and Other Cancers and Tumors under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for C7A.011
For C7A.011to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed C7A.011 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C7A.011 is the ICD-10-CM diagnosis code for malignant carcinoid tumor of the jejunum. A rare cancer that develops in hormone-producing cells of the jejunum, which is the middle section of the small intestine. C7A.011 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering malignant neuroendocrine tumors (c7a).
Under the CMS-HCC V28 risk adjustment model, C7A.011 maps to Lymphoma and Other Cancers (HCC 21) with a community, non-dual, aged base RAF weight of 0.671. Under the older CMS-HCC V24 model, C7A.011 maps to Breast, Prostate, and Other Cancers and Tumors (HCC 12) with a community, non-dual, aged base RAF weight of 0.150. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
The jejunum is the middle portion of the small intestine; ensure documentation clearly specifies this location. Because C7A.011 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for C7A.011 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •The jejunum is the middle portion of the small intestine; ensure documentation clearly specifies this location
- •Carcinoid tumors of the small intestine often have metastasized by diagnosis, so check for secondary site codes
Clinical Significance
Malignant carcinoid tumor of the jejunum is a neuroendocrine neoplasm arising in the middle segment of the small intestine. Jejunal carcinoids are midgut tumors more likely to cause carcinoid syndrome than foregut tumors, especially when liver metastases are present. They often present late with abdominal symptoms, bowel obstruction, or carcinoid syndrome.
Documentation Requirements
- ✓Pathological confirmation of neuroendocrine differentiation with malignant behavior
- ✓Tumor grade — Ki-67 index and mitotic count per WHO classification
- ✓Tumor size and depth of invasion
- ✓Staging — lymph node involvement and distant metastases (especially liver)
- ✓Functional status — 24-hour urinary 5-HIAA, chromogranin A levels
- ✓Presence of carcinoid syndrome symptoms
Commonly Confused Codes
- •C7A.010 — Malignant carcinoid tumor of duodenum; the jejunum is distal to the duodenum and requires different coding
- •C7A.012 — Malignant carcinoid tumor of ileum; distinguish jejunal from ileal location based on surgical or pathological findings
- •C7A.019 — Malignant carcinoid tumor of small intestine, unspecified; use C7A.011 when jejunum is confirmed
- •C17.1 — Primary malignant neoplasm of jejunum; adenocarcinoma uses C17 codes, not C7A codes