C7A.012
BillableMalignant carcinoid tumor of the ileum
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C7A.012 an HCC code?
Yes. C7A.012 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.012
For C7A.012to 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.012 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C7A.012 is the ICD-10-CM diagnosis code for malignant carcinoid tumor of the ileum. A rare cancer that develops in hormone-producing cells of the ileum, which is the last section of the small intestine. C7A.012 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.012 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.012 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 ileum is the distal (final) portion of the small intestine; distinguish from jejunum and duodenum. Because C7A.012 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.012 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •The ileum is the distal (final) portion of the small intestine; distinguish from jejunum and duodenum
- •Small intestine carcinoid tumors frequently present late with metastatic disease; review staging documentation
Clinical Significance
Malignant carcinoid tumor of the ileum is the most common location for small intestinal carcinoid tumors. Ileal carcinoids are midgut neuroendocrine tumors with a high propensity for lymph node and liver metastases at the time of diagnosis. They are a leading cause of carcinoid syndrome and may cause mesenteric fibrosis leading to bowel ischemia.
Documentation Requirements
- ✓Pathological confirmation with grade — Ki-67 index, mitotic rate
- ✓Tumor size, depth of invasion, and number of primary tumors (multifocality is common)
- ✓Mesenteric lymph node involvement — ileal carcinoids frequently metastasize to mesenteric nodes
- ✓Liver metastasis assessment — CT, MRI, or octreotide scan
- ✓24-hour urinary 5-HIAA and chromogranin A levels
- ✓Assessment for mesenteric fibrosis and bowel ischemia
Commonly Confused Codes
- •C7A.011 — Malignant carcinoid tumor of jejunum; ensure the tumor is specifically in the ileum, not the jejunum
- •C7A.019 — Malignant carcinoid tumor of small intestine, unspecified; use C7A.012 when ileum is confirmed
- •C17.2 — Primary malignant neoplasm of ileum; adenocarcinoma of ileum uses different coding
- •D3A.012 — Benign carcinoid tumor of ileum; verify malignant behavior before using C7A.012