D38.1 ICD-10-CM Code: Neoplasm of uncertain behavior of trachea, bronchus and lung
D38.1 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)
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
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
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
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 D38.1 an HCC code?
No. D38.1 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
- D38.1
- Description
- Neoplasm of uncertain behavior of trachea, bronchus and lung
- 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
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 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.
This code is commonly used for pulmonary nodules with uncertain pathology; ensure imaging findings are documented.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, 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