D3A.021
BillableBenign carcinoid tumor of the cecum
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D3A.021 an HCC code?
Yes. D3A.021 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.021
For D3A.021to 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.021 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D3A.021 is the ICD-10-CM diagnosis code for benign carcinoid tumor of the cecum. A benign neuroendocrine tumor found in the cecum, which is the first part of the large intestine. D3A.021 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.021 maps to Bladder, Colorectal, and Other Cancers (HCC 22) with a community, non-dual, aged base RAF weight of 0.363. D3A.021 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 documentation specifies cecum location to differentiate from other colon sites. Because D3A.021 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.021 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation specifies cecum location to differentiate from other colon sites
- •Note that carcinoid tumors in the cecum may have different clinical significance than in other colon locations
Clinical Significance
Benign carcinoid tumor of the cecum is a well-differentiated neuroendocrine tumor arising in the first portion of the large intestine. Cecal carcinoids are less common than appendiceal carcinoids and tend to be discovered at a larger size, often found incidentally during colonoscopy or surgery. Due to the right colon's larger diameter, cecal carcinoids may be asymptomatic until they reach significant size.
Documentation Requirements
- ✓Colonoscopy or surgical findings with biopsy-confirmed well-differentiated neuroendocrine tumor.
- ✓Document tumor size, depth of invasion, Ki-67 index, and whether the lesion was removed endoscopically or surgically.
- ✓Include any associated symptoms (right lower quadrant pain, bleeding, anemia) and follow-up surveillance colonoscopy plan.
Commonly Confused Codes
- •D3A.020 (appendix) is for appendiceal carcinoids, which are anatomically adjacent
- •D3A.022 (ascending colon) is for the next colonic segment
- •C7A.021 (malignant carcinoid of cecum) is for tumors with malignant behavior
- •D12.0 (benign neoplasm of cecum) covers other benign cecal tumors like polyps.