D3A.025
BillableBenign carcinoid tumor of the sigmoid colon
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D3A.025 an HCC code?
Yes. D3A.025 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.025
For D3A.025to 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.025 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D3A.025 is the ICD-10-CM diagnosis code for benign carcinoid tumor of the sigmoid colon. A benign neuroendocrine tumor found in the sigmoid colon, the S-shaped section of the large intestine just before the rectum. D3A.025 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.025 maps to Bladder, Colorectal, and Other Cancers (HCC 22) with a community, non-dual, aged base RAF weight of 0.363. D3A.025 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.
Confirm documentation specifies sigmoid colon location. Because D3A.025 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.025 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm documentation specifies sigmoid colon location
- •Note that sigmoid carcinoid tumors may have different management considerations than other sites
Clinical Significance
Benign carcinoid tumors of the sigmoid colon are rare neuroendocrine neoplasms typically discovered during routine colonoscopy. The sigmoid colon is a less common site for carcinoid tumors compared to the rectum or appendix, and these lesions generally have favorable outcomes when confirmed as benign on pathology.
Documentation Requirements
- ✓Documentation must identify the sigmoid colon as the specific location, confirmed by colonoscopy and biopsy.
- ✓The pathology report should confirm benign behavior with neuroendocrine differentiation markers (chromogranin A, synaptophysin).
- ✓Tumor size, depth of invasion, and any associated polyps should be recorded.
Commonly Confused Codes
- •D3A.026 (benign carcinoid of rectum) involves the adjacent anatomical segment and requires precise documentation to differentiate.
- •C7A.025 (malignant carcinoid of sigmoid colon) is used when malignant behavior is confirmed.
- •D3A.024 (benign carcinoid of descending colon) should be distinguished based on the anatomic transition at the descending-sigmoid junction.