What is ICD-10 code C7A.012?

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. It belongs to the ICD-10-CM chapter for neoplasms (c00-d49). C7A.012 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. C7A.012 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. C7A.012 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. C7A.012 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does C7A.012 map to under V28?

C7A.012 maps to CMS-HCC V28 HCC 21 (Lymphoma and Other Cancers). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

What documentation supports C7A.012?

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 Because C7A.012 maps to an HCC category, the documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. MEAT is generic documentation evidence, not a payer-specific rule.

2026 ICD-10-CM C7A.012: Malignant carcinoid tumor

C7A.012 maps to CMS-HCC V28 21. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

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Code lookupC7A.012Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neuroendocrine tumors (C7A)

C7A.012

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

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.

Buddy Insight

Malignant carcinoid tumor of the ileum is the most common location for small intestinal carcinoid tumors.

CMS-HCC V28

Mapped

HCC 21

Lymphoma and Other Cancers

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 012

HHS-HCC 012 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 12

Breast/Prostate/and Other Can...

Code-level coefficient reference

RXHCC

Mapped

HCC 22

Prostate, Breast, Bladder, an...

Code-level coefficient reference

Code Book Path

Official

C7A.0Malignant carcinoid tumors

C7A.01Malignant carcinoid tumors of the small intestine

C7A.012Malignant carcinoid tumor of the ileum

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for C7A.012 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for C7A.012 in this effective period.

Related Child Codes

Official

C7A.010Malignant carcinoid tumor of the duodenum

C7A.011Malignant carcinoid tumor of the jejunum

C7A.019Malignant carcinoid tumor of the small intestine, unspecified portion

Includes

Official

ICD-10-CM does not list Includes notes for C7A.012 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for C7A.012 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for C7A.012 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for C7A.012 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for C7A.012 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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

MEAT Support

HCC Buddy guidance

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

Audit Caution

HCC Buddy guidance

Not recognizing multifocality — ileal carcinoids frequently have multiple primary tumors in the same segment

Using unspecified small intestine code when ileal location is documented in operative or pathology reports

Failing to assess for and code liver metastases (C7B.02) which are present in up to 50% of cases at diagnosis

Missing carcinoid heart disease (right-sided valvular disease) which occurs in long-standing carcinoid syndrome

Common Mistakes

HCC Buddy guidance

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

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is C7A.012 an HCC code?

Yes. C7A.012 (Malignant carcinoid tumor of the ileum) maps to HCC 21, Lymphoma and Other Cancers under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.671. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: C7A.012 is billable and maps to V28 HCC 21, Lymphoma and Other Cancers. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: C7A.012
Description: Malignant carcinoid tumor of the ileum
HCC (V28): HCC 21 — Lymphoma and Other Cancers
RAF reference coefficient: 0.671
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 21, Lymphoma and Other Cancers

0.671

ESRDHCC 12, Breast/Prostate/and Other Cancers and Tumors

Not separately weighted

RxHCCHCC 22, Prostate, Breast, Bladder, and Other Cancers and Tumors

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work C7A.012 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for C7A.012

For C7A.012 to 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.

Coder workflow notes

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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 source-labeled community, non-dual, aged reference coefficient of 0.671. No V24 mapping is shown for C7A.012; use the applicable model and payment year when reviewing the V28 mapping. 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. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

The ileum is the distal (final) portion of the small intestine; distinguish from jejunum and duodenum. Because C7A.012 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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, source-labeled coefficient references, 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