C7A.019
BillableMalignant carcinoid tumor of the small intestine, unspecified portion
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C7A.019 an HCC code?
Yes. C7A.019 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.019
For C7A.019to 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.019 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C7A.019 is the ICD-10-CM diagnosis code for malignant carcinoid tumor of the small intestine, unspecified portion. A rare cancer that develops in hormone-producing cells somewhere in the small intestine, but the specific section cannot be identified. C7A.019 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.019 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.019 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.
Use this code when documentation indicates small intestine carcinoid but does not specify jejunum, ileum, or duodenum. Because C7A.019 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.019 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code when documentation indicates small intestine carcinoid but does not specify jejunum, ileum, or duodenum
- •Query the provider if any additional anatomical detail is available to assign a more specific code
Clinical Significance
Malignant carcinoid tumor of the small intestine with unspecified portion indicates a confirmed small bowel neuroendocrine neoplasm whose specific segment (duodenum, jejunum, or ileum) cannot be determined. This may occur when surgical or endoscopic localization is inconclusive. Provider query should be attempted to determine the exact segment for more specific coding.
Documentation Requirements
- ✓Pathological confirmation of neuroendocrine tumor with malignant behavior
- ✓Documentation explaining why the specific small intestine segment cannot be identified
- ✓Imaging and staging workup — CT, octreotide scan, PET
- ✓Biochemical markers — 5-HIAA, chromogranin A
- ✓Provider query documenting attempt to clarify the specific segment
Commonly Confused Codes
- •C7A.010 — Malignant carcinoid tumor of duodenum; use when duodenum is documented
- •C7A.011 — Malignant carcinoid tumor of jejunum; use when jejunum is documented
- •C7A.012 — Malignant carcinoid tumor of ileum; use when ileum is documented
- •C17.9 — Primary malignant neoplasm of small intestine, unspecified; adenocarcinoma uses different coding from carcinoid