D3A.019
BillableBenign carcinoid tumor of the small intestine, unspecified portion
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D3A.019 an HCC code?
Yes. D3A.019 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.019
For D3A.019to 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.019 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D3A.019 is the ICD-10-CM diagnosis code for benign carcinoid tumor of the small intestine, unspecified portion. A benign neuroendocrine tumor of the small intestine when the exact portion (duodenum, jejunum, or ileum) is not specified. D3A.019 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.019 maps to Bladder, Colorectal, and Other Cancers (HCC 22) with a community, non-dual, aged base RAF weight of 0.363. D3A.019 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.
Use this code only when documentation does not specify which part of the small intestine is affected. Because D3A.019 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.019 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when documentation does not specify which part of the small intestine is affected
- •Query the provider if possible to obtain more specific anatomical location for accurate coding
Clinical Significance
Benign carcinoid tumor of the small intestine, unspecified portion, represents a well-differentiated neuroendocrine tumor when the specific segment (duodenum, jejunum, or ileum) has not been determined or documented. This code should be temporary, as surgical or imaging reports typically identify the exact small bowel segment involved. Small intestinal carcinoids are the most common small bowel tumors overall.
Documentation Requirements
- ✓Pathologic confirmation of a well-differentiated neuroendocrine tumor of the small intestine with benign features.
- ✓Every effort should be made to identify the specific segment from surgical reports, imaging, or endoscopy findings.
- ✓Document the reason the specific portion cannot be determined and any planned follow-up to establish the primary site.