D3A.012 ICD-10-CM Code: Benign carcinoid tumor of the ileum
D3A.012 maps to CMS-HCC V28 22. 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 neuroendocrine tumors (D3A)
D3A.012
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceBenign carcinoid tumor of the ileum
A benign (non-cancerous) neuroendocrine tumor found in the ileum, which is the last part of the small intestine.
Buddy Insight
Benign carcinoid tumor of the ileum is a well-differentiated neuroendocrine tumor of the terminal small intestine, which is the most common location for small bowel carcinoid tumors.
CMS-HCC V28
MappedHCC 22
Coefficient HCC 22: 0.363 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
MappedHCC 22
Code-level coefficient reference
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for D3A.012. Check the code and parent instructions in the Code Book.
Excludes 2
Official- benign pancreatic islet cell tumors (D13.7)Inherited from D3A
Related Codes
Includes
OfficialNo Includes notes are included in this display for D3A.012. Check the code and parent instructions in the Code Book.
Excludes 1
OfficialNo Excludes 1 notes are included in this display for D3A.012. Check the code and parent instructions in the Code Book.
Code First
OfficialNo Code First sequencing instructions are included in this display for D3A.012. Check the code and parent instructions in the Code Book.
Use Additional
Official- code to identify any associated endocrine syndrome, such as:Inherited from D3A
- carcinoid syndrome (E34.00)Inherited from D3A
Code Also
Official- any associated multiple endocrine neoplasia [MEN] syndromes (E31.2-)Inherited from D3A
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 D3A.012 an HCC code?
Yes. D3A.012 (Benign carcinoid tumor of the ileum) maps to HCC 22, Bladder, Colorectal, and Other Cancers under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.363. 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: D3A.012 is billable and maps to V28 HCC 22, Bladder, Colorectal, and Other Cancers. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- D3A.012
- Description
- Benign carcinoid tumor of the ileum
- HCC (V28)
- HCC 22 — Bladder, Colorectal, and Other Cancers
- RAF reference coefficient
- 0.363
- 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 D3A.012 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for D3A.012
For D3A.012, 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
D3A.012 is the ICD-10-CM diagnosis code for benign carcinoid tumor of the ileum. A benign (non-cancerous) neuroendocrine tumor found in the ileum, which is the last part of the small intestine. D3A.012 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering benign neuroendocrine tumors (d3a).
Under the CMS-HCC V28 risk adjustment model, D3A.012 maps to Bladder, Colorectal, and Other Cancers (HCC 22) with a source-labeled community, non-dual, aged reference coefficient of 0.363. No V24 mapping is shown for D3A.012; use the applicable model and payment year when reviewing the V28 mapping. 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.
Verify the specific location is documented as ileum to distinguish from other small intestine sites. For D3A.012, 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 D3A.012 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify the specific location is documented as ileum to distinguish from other small intestine sites
- •Confirm the tumor is benign; malignant carcinoid tumors use different codes in the C7A category
Clinical Significance
Benign carcinoid tumor of the ileum is a well-differentiated neuroendocrine tumor of the terminal small intestine, which is the most common location for small bowel carcinoid tumors. Ileal carcinoids have the highest propensity among gastrointestinal carcinoids for producing serotonin and causing carcinoid syndrome, even when classified as benign. They may cause bowel obstruction, mesenteric fibrosis, or ischemia due to a desmoplastic reaction.
Documentation Requirements
- ✓Surgical pathology confirming a well-differentiated neuroendocrine tumor with low Ki-67 and low mitotic rate in the ileum.
- ✓Document tumor size, number of tumors (ileal carcinoids are frequently multifocal), mesenteric involvement, and any associated fibrotic changes.
- ✓Include biochemical markers (chromogranin A, 5-HIAA) and imaging findings from CT or octreotide scan.