D12.1 ICD-10-CM Code: Benign neoplasm of appendix
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Neoplasms (C00-D49) / Benign neoplasms, except benign neuroendocrine tumors (D10-D36)
D12.1
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceBenign neoplasm of appendix
A benign (non-cancerous) tumor located in the appendix, a small tube-shaped organ attached to the cecum.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for D12.1 in this effective period.
Excludes 2
Official- benign carcinoid tumors of the large intestine and rectum (D3A.02-)
- polyp of colon NOS (K63.5)
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for D12.1 in this effective period.
Excludes 1
Official- benign carcinoid tumor of the appendix (D3A.020)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for D12.1 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for D12.1 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for D12.1 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is D12.1 an HCC code?
No. D12.1 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
D12.1 is the ICD-10-CM diagnosis code for benign neoplasm of appendix. A benign (non-cancerous) tumor located in the appendix, a small tube-shaped organ attached to the cecum. D12.1 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering benign neoplasms, except benign neuroendocrine tumors (d10-d36).
D12.1 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Verify the neoplasm is in the appendix itself and not in adjacent structures like the cecum.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for D12.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify the neoplasm is in the appendix itself and not in adjacent structures like the cecum
- •Note whether the appendix was removed (appendectomy) during treatment or diagnosis
Excludes 1, Do NOT code together
- benign carcinoid tumor of the appendix (D3A.020)