What is ICD-10 code C7A.019?

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. It belongs to the ICD-10-CM chapter for neoplasms (c00-d49). C7A.019 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. C7A.019 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.019 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.019 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.

What is the V28 vs V24 difference for C7A.019?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For C7A.019, V28 maps to Lymphoma and Other Cancers at RAF 0.671 while V24 mapped to Breast, Prostate, and Other Cancers and Tumors at RAF 0.150. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting C7A.019?

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 Because C7A.019 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

2026 ICD-10-CM C7A.019: Malignant carcinoid tumor

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupC7A.019Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

C7A.019

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

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.

Buddy Insight

CMS-HCC V28

Mapped

HCC 21

Lymphoma and Other Cancers

RAF 0.671

CMS-HCC V24

Mapped

HCC 12

Breast, Prostate, and Other C...

RAF 0.150

ACA/HHS

Mapped

HCC 12

HHS-HCC 12

Varies by metal level

ESRD/PACE

Mapped

HCC 12

Breast, Prostate, and Other C...

RAF 0.045

RXHCC

Mapped

HCC 22

Cancer, Other Specified Sites

RAF 0.124

Code Book Path

Official

C7A.0Malignant carcinoid tumors

C7A.01Malignant carcinoid tumors of the small intestine

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

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for C7A.019 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for C7A.019 in this effective period.

Related Child Codes

Official

C7A.010Malignant carcinoid tumor of the duodenum

C7A.011Malignant carcinoid tumor of the jejunum

C7A.012Malignant carcinoid tumor of the ileum

Includes

Official

ICD-10-CM does not list Includes notes for C7A.019 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for C7A.019 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for C7A.019 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for C7A.019 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for C7A.019 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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

MEAT Support

HCC Buddy guidance

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

Audit Caution

HCC Buddy guidance

Using this unspecified code when operative or pathology reports identify the exact small intestine segment

Not querying the provider or reviewing surgical notes that may specify duodenum, jejunum, or ileum

Confusing small intestinal adenocarcinoma with carcinoid tumors

Failing to code metastatic sites (C7B codes) when secondary neuroendocrine deposits are present

Common Mistakes

HCC Buddy guidance

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

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.019 an HCC code?

Yes. C7A.019 (Malignant carcinoid tumor of the small intestine, unspecified portion) maps to Lymphoma and Other Cancers under the CMS-HCC V28 risk adjustment model (and Breast, Prostate, and Other Cancers and Tumors under V24), with a community non-dual aged RAF of 0.671. It is billable for payment year 2026.

Coder answer: C7A.019 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.019
Description: Malignant carcinoid tumor of the small intestine, unspecified portion
HCC (V28): HCC 21 — Lymphoma and Other Cancers
RAF: 0.671
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 21, Lymphoma and Other Cancers

0.671

V24HCC 12, Breast, Prostate, and Other Cancers and Tumors

0.150

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

0.045

RxHCCHCC 22, Cancer, Other Specified Sites

0.124

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work C7A.019 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for C7A.019

For C7A.019 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.019 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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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