C7A.094
BillableMalignant carcinoid tumor of the foregut, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C7A.094 an HCC code?
Yes. C7A.094 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.094
For C7A.094to 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.094 during that encounter — not just copy-forwarded from a problem list.
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 community, non-dual, aged base RAF weight of 0.671. Under the older CMS-HCC V24 model, C7A.094 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.
Foregut carcinoid is a classification category; if specific site is documented, use more specific codes (C7A.090-C7A.093). Because C7A.094 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.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