What is ICD-10 code C7A.096?

C7A.096 is the ICD-10-CM diagnosis code for Malignant carcinoid tumor of the hindgut, unspecified. A rare cancer of hormone-producing cells in the lower digestive tract (hindgut region including colon and rectum) when the exact location is not specified. It belongs to the ICD-10-CM chapter for neoplasms (c00-d49). C7A.096 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. C7A.096 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.096 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.096 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.

Which HCC does C7A.096 map to under V28?

C7A.096 maps to CMS-HCC V28 21 (Lymphoma and Other Cancers). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does C7A.096 pay in RAF?

C7A.096 carries a community, non-dual, aged (CNA) RAF weight of 0.671 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for C7A.096?

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.096, 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 documentation supports C7A.096?

Hindgut carcinoid is a classification category; if specific site is documented, use more specific codes (C7A.020-C7A.029) Hindgut carcinoids typically have better prognosis than foregut tumors; document stage and grade when available Because C7A.096 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. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. MEAT is generic documentation evidence, not a payer-specific rule.

2026 ICD-10-CM C7A.096: Malignant carcinoid

C7A.096 maps to CMS-HCC V28 21 (RAF 0.671). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools

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Code lookupC7A.096Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

C7A.096

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

Malignant carcinoid tumor of the hindgut, unspecified

A rare cancer of hormone-producing cells in the lower digestive tract (hindgut region including colon and rectum) when the exact location is not specified.

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.09Malignant carcinoid tumors of other sites

C7A.096Malignant carcinoid tumor of the hindgut, unspecified

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for C7A.096 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for C7A.096 in this effective period.

Related Child 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.094Malignant carcinoid tumor of the foregut, unspecified

Includes

Official

ICD-10-CM does not list Includes notes for C7A.096 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for C7A.096 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for C7A.096 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for C7A.096 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for C7A.096 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Pathology confirming neuroendocrine/carcinoid histology

Documentation explaining why the specific hindgut segment cannot be identified

Tumor size (critical for rectal carcinoids — tumors less than 1 cm have excellent prognosis)

Depth of invasion and lymphovascular invasion status

MEAT Support

HCC Buddy guidance

Pathology confirming neuroendocrine/carcinoid histology

Documentation explaining why the specific hindgut segment cannot be identified

Tumor size (critical for rectal carcinoids — tumors less than 1 cm have excellent prognosis)

Depth of invasion and lymphovascular invasion status

Audit Caution

HCC Buddy guidance

Using this unspecified hindgut code when the specific colon segment or rectum is documented elsewhere in the record

Confusing hindgut and midgut classification at the colon level — the boundary is at the hepatic flexure

Coding small, incidentally discovered rectal carcinoids as malignant without pathologic confirmation of malignant behavior

Failing to code metastatic disease separately when hindgut carcinoid has spread

Common Mistakes

HCC Buddy guidance

C7A.020-C7A.029 — Site-specific large intestine carcinoid codes: Use these when the specific colon segment or rectum is documented

C7A.095 — Malignant carcinoid tumor of the midgut, unspecified: Midgut includes proximal colon through hepatic flexure

C20 — Malignant neoplasm of rectum: Use for adenocarcinoma of the rectum, not carcinoid

D3A.029 — Benign carcinoid tumor of the large intestine: Use for confirmed benign behavior

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.096 an HCC code?

Yes. C7A.096 (Malignant carcinoid tumor of the hindgut, unspecified) 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.096 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.096
Description: Malignant carcinoid tumor of the hindgut, unspecified
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.096 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for C7A.096

For C7A.096 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.096 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

C7A.096 is the ICD-10-CM diagnosis code for malignant carcinoid tumor of the hindgut, unspecified. A rare cancer of hormone-producing cells in the lower digestive tract (hindgut region including colon and rectum) when the exact location is not specified. C7A.096 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.096 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.096 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.

Hindgut carcinoid is a classification category; if specific site is documented, use more specific codes (C7A.020-C7A.029). Because C7A.096 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.096 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Hindgut carcinoid is a classification category; if specific site is documented, use more specific codes (C7A.020-C7A.029)
•Hindgut carcinoids typically have better prognosis than foregut tumors; document stage and grade when available

Clinical Significance

Malignant carcinoid tumor of the hindgut represents a neuroendocrine malignancy arising from hindgut-derived structures (distal transverse colon, descending colon, sigmoid, and rectum) when the specific segment is not documented. Hindgut carcinoids rarely produce serotonin and are less likely to cause carcinoid syndrome compared to midgut tumors. Rectal carcinoids are the most common hindgut carcinoid and are often discovered incidentally during colonoscopy.

Documentation Requirements

✓Pathology confirming neuroendocrine/carcinoid histology
✓Documentation explaining why the specific hindgut segment cannot be identified
✓Tumor size (critical for rectal carcinoids — tumors less than 1 cm have excellent prognosis)
✓Depth of invasion and lymphovascular invasion status
✓Ki-67 proliferation index and tumor grade
✓Surveillance colonoscopy schedule

Commonly Confused Codes

•C7A.020-C7A.029: Site-specific large intestine carcinoid codes: Use these when the specific colon segment or rectum is documented
•C7A.095: Malignant carcinoid tumor of the midgut, unspecified: Midgut includes proximal colon through hepatic flexure
•C20: Malignant neoplasm of rectum: Use for adenocarcinoma of the rectum, not carcinoid
•D3A.029: Benign carcinoid tumor of the large intestine: Use for confirmed benign behavior