C7A.090
BillableMalignant carcinoid tumor of the bronchus and lung
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C7A.090 an HCC code?
Yes. C7A.090 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.090
For C7A.090to 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.090 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C7A.090 is the ICD-10-CM diagnosis code for malignant carcinoid tumor of the bronchus and lung. A rare cancer arising from hormone-producing cells in the lungs or breathing tubes that has spread or is actively growing. C7A.090 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.090 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.090 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.
Document whether the tumor is in the bronchus, lung, or both; laterality (left/right) may be needed for complete coding. Because C7A.090 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.090 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document whether the tumor is in the bronchus, lung, or both; laterality (left/right) may be needed for complete coding
- •Lung carcinoid tumors are often discovered incidentally; confirm malignant behavior and stage if available
Clinical Significance
Malignant carcinoid tumor of the bronchus and lung is a neuroendocrine malignancy arising from pulmonary neuroendocrine cells. These tumors can be typical (low grade) or atypical (intermediate grade) and may present with hemoptysis, cough, or recurrent pneumonia. Lung carcinoids account for approximately 1-2% of all lung cancers and carry different prognosis and treatment protocols than standard lung carcinomas.
Documentation Requirements
- ✓Pathology confirming neuroendocrine (carcinoid) histology versus non-small cell or small cell lung cancer
- ✓Typical versus atypical carcinoid designation from pathology
- ✓Laterality (right or left lung/bronchus)
- ✓Location within the lung (central vs peripheral, specific lobe)
- ✓Current treatment status and staging information
- ✓Presence or absence of carcinoid syndrome
Commonly Confused Codes
- •C34.90 — Malignant neoplasm of unspecified part of unspecified bronchus or lung: Use for non-neuroendocrine lung cancers (adenocarcinoma, squamous cell); C7A.090 is specifically for carcinoid histology
- •D3A.090 — Benign carcinoid tumor of the bronchus and lung: Use D3A.090 for confirmed benign behavior; C7A.090 requires confirmed malignancy
- •C7A.091 — Malignant carcinoid tumor of the thymus: Thymic carcinoids are anatomically close but require distinction from bronchial/lung carcinoids
- •C78.00 — Secondary malignant neoplasm of unspecified lung: Do not confuse primary lung carcinoid with metastatic disease to the lung