D37.5 ICD-10-CM Code: Neoplasm of uncertain behavior of rectum
D37.5 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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FY 2026 Apr update / Neoplasms (C00-D49) / Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (D37-D48)
D37.5
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceNeoplasm of uncertain behavior of rectum
A growth in the rectum with uncertain behavior that needs further investigation to determine whether it is benign or malignant.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Neoplasm of uncertain behavior of rectosigmoid junction
Excludes 2
OfficialNo Excludes 2 notes are included in this display for D37.5. Check the code and parent instructions in the Code Book.
Related Codes
Includes
OfficialNo Includes notes are included in this display for D37.5. Check the code and parent instructions in the Code Book.
Excludes 1
Official- neoplasms of unspecified behavior (D49.-)Inherited from D37-D48, D37
- stromal tumors of uncertain behavior of digestive system (D48.1-)Inherited from D37-D48, D37
Code First
OfficialNo Code First sequencing instructions are included in this display for D37.5. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for D37.5. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for D37.5. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
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 D37.5 an HCC code?
No. D37.5 is a billable ICD-10-CM code with no mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models.
- Code
- D37.5
- Description
- Neoplasm of uncertain behavior of rectum
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- Yes
- Payment year
- 2026
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
D37.5 is the ICD-10-CM diagnosis code for neoplasm of uncertain behavior of rectum. A growth in the rectum with uncertain behavior that needs further investigation to determine whether it is benign or malignant. D37.5 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (d37-d48).
D37.5 is a billable ICD-10-CM code, but the current payload does not show a mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.
Distinguish between rectal lesions (D37.5) and colonic lesions (D37.4) based on anatomical location documented in endoscopy reports.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for D37.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Distinguish between rectal lesions (D37.5) and colonic lesions (D37.4) based on anatomical location documented in endoscopy reports
- •Ensure pathology confirms uncertain behavior classification; coordinate with gastroenterology for follow-up recommendations