C7A.025
BillableMalignant carcinoid tumor of the sigmoid colon
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C7A.025 an HCC code?
Yes. C7A.025 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.025
For C7A.025to 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.025 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C7A.025 is the ICD-10-CM diagnosis code for malignant carcinoid tumor of the sigmoid colon. A rare cancer that develops in hormone-producing cells of the sigmoid colon, the S-shaped section of the large intestine just before the rectum. C7A.025 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.025 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.025 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 sigmoid colon is the most common site for colorectal carcinoid tumors. Because C7A.025 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.025 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •The sigmoid colon is the most common site for colorectal carcinoid tumors
- •Verify documentation distinguishes sigmoid carcinoid from other sigmoid malignancies and from rectal tumors
Clinical Significance
Malignant carcinoid tumor of the sigmoid colon is a hindgut neuroendocrine neoplasm arising in the S-shaped terminal segment of the colon. Sigmoid carcinoids are less common than rectal carcinoids but share similar biological behavior. They are typically discovered during colonoscopy and require surgical resection with assessment of lymph node involvement.
Documentation Requirements
- ✓Pathological confirmation of neuroendocrine differentiation with malignant behavior
- ✓Tumor grade — Ki-67 index and mitotic rate per WHO classification
- ✓Tumor size — critical for management decisions (small tumors may be removed endoscopically)
- ✓Colonoscopic location confirmed as sigmoid versus descending colon or rectum
- ✓Staging — lymph node assessment and distant metastasis evaluation
- ✓Depth of invasion — submucosal versus transmural
Commonly Confused Codes
- •C18.7 — Primary malignant neoplasm of sigmoid colon; adenocarcinoma of sigmoid uses different coding
- •C7A.026 — Malignant carcinoid tumor of rectum; the sigmoid-rectal junction requires careful anatomical distinction
- •C7A.024 — Malignant carcinoid tumor of descending colon; proximal to the sigmoid
- •D3A.025 — Benign carcinoid tumor of sigmoid colon; confirm malignant behavior before assigning C7A.025