D38.1 ICD-10-CM Code: Neoplasm of uncertain behavior of trachea, bronchus and lung
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) / Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (D37-D48)
D38.1
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceNeoplasm of uncertain behavior of trachea, bronchus and lung
A growth in the windpipe, airways, or lungs that cannot yet be determined to be cancer or benign. These tumors require close follow-up and possibly repeat testing.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for D38.1 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for D38.1 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for D38.1 in this effective period.
Excludes 1
Official- neoplasm of uncertain behavior of heart (D48.7)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for D38.1 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for D38.1 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for D38.1 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 D38.1 an HCC code?
No. D38.1 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
D38.1 is the ICD-10-CM diagnosis code for neoplasm of uncertain behavior of trachea, bronchus and lung. A growth in the windpipe, airways, or lungs that cannot yet be determined to be cancer or benign. These tumors require close follow-up and possibly repeat testing. D38.1 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).
D38.1 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.
This code is commonly used for pulmonary nodules with uncertain pathology; ensure imaging findings are documented.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for D38.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code is commonly used for pulmonary nodules with uncertain pathology; ensure imaging findings are documented
- •Distinguish between central airway lesions (trachea/bronchus) and peripheral lung lesions in clinical notes