D35.3 ICD-10-CM Code: Benign neoplasm of craniopharyngeal duct
D35.3 maps to CMS-HCC V28 23. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools
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FY 2026 Apr update / Neoplasms (C00-D49) / Benign neoplasms, except benign neuroendocrine tumors (D10-D36)
D35.3
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceBenign neoplasm of craniopharyngeal duct
A noncancerous tumor of the craniopharyngeal duct, a remnant structure in the brain that can occasionally develop tumors.
Buddy Insight
Benign neoplasm of the craniopharyngeal duct typically refers to craniopharyngioma, a rare benign epithelial tumor arising from remnants of Rathke's pouch in the sellar and suprasellar region.
CMS-HCC V28
MappedHCC 23
Coefficient HCC 23: 0.186 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 012
Code-level coefficient reference
ESRD/PACE
MappedHCC 12
Code-level coefficient reference
RXHCC
MappedHCC 22
Code-level coefficient reference
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for D35.3. Check the code and parent instructions in the Code Book.
Excludes 2
OfficialNo Excludes 2 notes are included in this display for D35.3. Check the code and parent instructions in the Code Book.
Related Codes
Includes
OfficialNo Includes notes are included in this display for D35.3. Check the code and parent instructions in the Code Book.
Excludes 1
Official- benign neoplasm of endocrine pancreas (D13.7)Inherited from D35
- benign neoplasm of ovary (D27.-)Inherited from D35
- benign neoplasm of testis (D29.2.-)Inherited from D35
- benign neoplasm of thymus (D15.0)Inherited from D35
Code First
OfficialNo Code First sequencing instructions are included in this display for D35.3. Check the code and parent instructions in the Code Book.
Use Additional
Official- code to identify any functional activityInherited from D35
Code Also
OfficialNo Code Also instructions are included in this display for D35.3. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 D35.3 an HCC code?
Yes. D35.3 (Benign neoplasm of craniopharyngeal duct) maps to HCC 23, Prostate, Breast, and Other Cancers and Tumors under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.186. 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: D35.3 is billable and maps to V28 HCC 23, Prostate, Breast, and Other Cancers and Tumors. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- D35.3
- Description
- Benign neoplasm of craniopharyngeal duct
- HCC (V28)
- HCC 23 — Prostate, Breast, and Other Cancers and Tumors
- RAF reference coefficient
- 0.186
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 D35.3 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for D35.3
For D35.3, 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
D35.3 is the ICD-10-CM diagnosis code for benign neoplasm of craniopharyngeal duct. A noncancerous tumor of the craniopharyngeal duct, a remnant structure in the brain that can occasionally develop tumors. D35.3 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering benign neoplasms, except benign neuroendocrine tumors (d10-d36).
Under the CMS-HCC V28 risk adjustment model, D35.3 maps to Prostate, Breast, and Other Cancers and Tumors (HCC 23) with a source-labeled community, non-dual, aged reference coefficient of 0.186. 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.
Craniopharyngeal duct tumors are rare; ensure pathology confirms benign diagnosis. For D35.3, 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 D35.3 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Craniopharyngeal duct tumors are rare; ensure pathology confirms benign diagnosis
- •These tumors are often diagnosed incidentally on imaging; document location and size for clinical correlation
Clinical Significance
Benign neoplasm of the craniopharyngeal duct typically refers to craniopharyngioma, a rare benign epithelial tumor arising from remnants of Rathke's pouch in the sellar and suprasellar region. Despite benign histology, craniopharyngiomas are clinically challenging due to their tendency to adhere to critical structures including the hypothalamus, optic chiasm, and pituitary stalk. They can cause significant endocrine dysfunction, visual impairment, and hydrocephalus.
Documentation Requirements
- ✓MRI demonstrating the characteristic cystic and solid sellar/suprasellar mass, often with calcification.
- ✓Document visual field testing results, comprehensive pituitary hormonal evaluation, and assessment of hypothalamic function including diabetes insipidus screening.
- ✓If resected, pathology should confirm adamantinomatous or papillary craniopharyngioma subtype.
- ✓Treatment plan and endocrine replacement therapy details should be recorded.
Commonly Confused Codes
- •D35.2 (pituitary adenoma) is a different sellar tumor with distinct imaging and pathology
- •D35.4 (pineal gland) is in a different anatomical location
- •D44.4 (craniopharyngeal duct, uncertain behavior) would be used if behavior is indeterminate
- •Rathke cleft cyst is a non-neoplastic lesion coded differently.