C7A.094 maps to CMS-HCC V28 21. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC Buddy coding tools

ICD-10-CM Code View

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Code lookupC7A.094

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

C7A.094

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

Malignant carcinoid tumor of the foregut, unspecified

A rare cancer of hormone-producing cells in the upper digestive tract (foregut region including esophagus, stomach, and duodenum) when the exact location is not specified.

Buddy Insight

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 21

Lymphoma and Other Cancers

Coefficient HCC 21: 0.671 (Community Non-Dual Aged (CNA))

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.09Malignant carcinoid tumors of other sites C7A.094Malignant carcinoid tumor of the foregut, unspecified

Inclusion Terms

Official

No inclusion terms are included in this display for C7A.094. Check the code and parent instructions in the Code Book.

Excludes 2

Official

malignant pancreatic islet cell tumors (C25.4)Inherited from C7A
Merkel cell carcinoma (C4A.-)Inherited from C7A

Related Codes

Official

C7A.090Malignant carcinoid tumor of the bronchus and lung C7A.091Malignant carcinoid tumor of the thymus C7A.092Malignant carcinoid tumor of the stomach C7A.093Malignant carcinoid tumor of the kidney C7A.095Malignant carcinoid tumor of the midgut, unspecified

Includes

Official

No Includes notes are included in this display for C7A.094. Check the code and parent instructions in the Code Book.

Excludes 1

Official

No Excludes 1 notes are included in this display for C7A.094. Check the code and parent instructions in the Code Book.

Code First

Official

No Code First sequencing instructions are included in this display for C7A.094. Check the code and parent instructions in the Code Book.

Use Additional

Official

code to identify any associated endocrine syndrome, such as:Inherited from C7A
carcinoid syndrome (E34.00)Inherited from C7A

Code Also

Official

any associated multiple endocrine neoplasia [MEN] syndromes (E31.2-)Inherited from C7A

Buddy Documentation Tip

HCC Buddy guidance

Pathology confirming neuroendocrine/carcinoid histology

Documentation that the specific foregut site cannot be determined despite appropriate workup

Imaging results (CT, octreotide scan, or Gallium-68 DOTATATE PET) attempted to localize the primary

Hormone secretion profile (serotonin, histamine, ACTH, 5-HIAA levels)

MEAT Support

HCC Buddy guidance

Pathology confirming neuroendocrine/carcinoid histology

Documentation that the specific foregut site cannot be determined despite appropriate workup

Imaging results (CT, octreotide scan, or Gallium-68 DOTATATE PET) attempted to localize the primary

Hormone secretion profile (serotonin, histamine, ACTH, 5-HIAA levels)

Audit Caution

HCC Buddy guidance

Using this unspecified code when a more specific foregut site (bronchus, thymus, stomach) has been identified in the record

Confusing foregut with midgut or hindgut classification — foregut includes structures above the ligament of Treitz

Failing to query the provider for a more specific anatomic site when imaging is available

Not coding associated endocrine syndromes (Cushing, acromegaly) when caused by ectopic hormone production

Common Mistakes

HCC Buddy guidance

C7A.090-C7A.093 — Site-specific foregut carcinoid codes: Use these more specific codes when the bronchus/lung, thymus, stomach, or kidney is identified as the primary site

C7A.095 — Malignant carcinoid tumor of the midgut, unspecified: Midgut carcinoids arise from jejunum/ileum/appendix/ascending colon — different embryologic origin

C7A.098 — Malignant carcinoid tumors of other sites: Use when the site is known but does not fit standard categories

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.094 an HCC code?

Yes. C7A.094 (Malignant carcinoid tumor of the foregut, unspecified) 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.094 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.094
Description: Malignant carcinoid tumor of the foregut, unspecified
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.094 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for C7A.094

For C7A.094, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

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

Coder workflow notes

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What This Code Means

C7A.094 is the ICD-10-CM diagnosis code for malignant carcinoid tumor of the foregut, unspecified. A rare cancer of hormone-producing cells in the upper digestive tract (foregut region including esophagus, stomach, and duodenum) when the exact location is not specified. C7A.094 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.094 maps to Lymphoma and Other Cancers (HCC 21) with a source-labeled community, non-dual, aged reference coefficient of 0.671. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. 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.

Foregut carcinoid is a classification category; if specific site is documented, use more specific codes (C7A.090-C7A.093). For C7A.094, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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.094 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Foregut carcinoid is a classification category; if specific site is documented, use more specific codes (C7A.090-C7A.093)
•Review pathology reports to confirm foregut origin and rule out other neuroendocrine tumors

Clinical Significance

Malignant carcinoid tumor of the foregut represents a neuroendocrine malignancy originating in the foregut-derived structures (esophagus, stomach, duodenum, upper jejunum, bronchi, thymus) when the specific organ cannot be determined. Foregut carcinoids tend to produce atypical carcinoid syndrome with histamine release causing flushing without cyanosis, and may secrete ACTH or growth hormone. This unspecified designation should prompt further workup to identify the exact primary site.

Documentation Requirements

✓Pathology confirming neuroendocrine/carcinoid histology
✓Documentation that the specific foregut site cannot be determined despite appropriate workup
✓Imaging results (CT, octreotide scan, or Gallium-68 DOTATATE PET) attempted to localize the primary
✓Hormone secretion profile (serotonin, histamine, ACTH, 5-HIAA levels)
✓Presence or absence of carcinoid syndrome and its specific symptoms

Commonly Confused Codes

•C7A.090-C7A.093: Site-specific foregut carcinoid codes: Use these more specific codes when the bronchus/lung, thymus, stomach, or kidney is identified as the primary site
•C7A.095: Malignant carcinoid tumor of the midgut, unspecified: Midgut carcinoids arise from jejunum/ileum/appendix/ascending colon: different embryologic origin
•C7A.098: Malignant carcinoid tumors of other sites: Use when the site is known but does not fit standard categories