D3A.012
BillableBenign carcinoid tumor of the ileum
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D3A.012 an HCC code?
Yes. D3A.012 maps to Bladder, Colorectal, and Other Cancers under the CMS-HCC V28 risk adjustment model.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for D3A.012
For D3A.012to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- 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
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed D3A.012 during that encounter — not just copy-forwarded from a problem list.
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 community, non-dual, aged base RAF weight of 0.363. D3A.012 was not retained as a payment HCC under the older V24 model, so V28 introduced or recategorized it during the 2024–2026 phase-in. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Verify the specific location is documented as ileum to distinguish from other small intestine sites. Because D3A.012 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, 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.
Commonly Confused Codes
- •D3A.011 (jejunum) is for the mid-small intestine
- •D3A.019 (small intestine, unspecified) should not be used when ileal location is documented
- •C7A.012 (malignant carcinoid of ileum) is for tumors with malignant features
- •D3A.020 (appendix) is for the adjacent anatomical structure.