What is ICD-10 code D3A.025?

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. It belongs to the ICD-10-CM chapter for neoplasms (c00-d49). D3A.025 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. D3A.025 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. D3A.025 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. D3A.025 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does D3A.025 map to under V28?

D3A.025 maps to CMS-HCC V28 22 (Bladder, Colorectal, and Other Cancers). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does D3A.025 pay in RAF?

D3A.025 carries a community, non-dual, aged (CNA) RAF weight of 0.363 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for D3A.025?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. D3A.025 is a payment HCC under V28 (Bladder, Colorectal, and Other Cancers) but was not retained as a payment HCC under V24. Both models can still appear in legacy data and in payer-specific lookback periods.

2026 ICD-10-CM D3A.025: Benign carcinoid tumor

D3A.025 maps to CMS-HCC V28 22 (RAF 0.363). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC Buddy coding tools

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Code lookupD3A.025Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Neoplasms (C00-D49) / Benign neuroendocrine tumors (D3A)

D3A.025

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

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.

Buddy Insight

Benign carcinoid tumors of the sigmoid colon are rare neuroendocrine neoplasms typically discovered during routine colonoscopy.

CMS-HCC V28

Mapped

HCC 22

Bladder, Colorectal, and Othe...

RAF 0.363

CMS-HCC V24

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

Mapped

HCC 22

Cancer, Other Specified Sites

RAF 0.124

Code Book Path

Official

D3A.0Benign carcinoid tumors

D3A.02Benign carcinoid tumors of the appendix, large intestine, and rectum

D3A.025Benign carcinoid tumor of the sigmoid colon

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for D3A.025 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for D3A.025 in this effective period.

Related Child Codes

Official

D3A.020Benign carcinoid tumor of the appendix

D3A.021Benign carcinoid tumor of the cecum

D3A.022Benign carcinoid tumor of the ascending colon

D3A.023Benign carcinoid tumor of the transverse colon

D3A.024Benign carcinoid tumor of the descending colon

Includes

Official

ICD-10-CM does not list Includes notes for D3A.025 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for D3A.025 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for D3A.025 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for D3A.025 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for D3A.025 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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.

MEAT Support

HCC Buddy guidance

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.

Audit Caution

HCC Buddy guidance

Sigmoid and rectal carcinoids may have different management approaches, so accurate site documentation is critical.

Do not assume sigmoid location when the provider documents a rectosigmoid lesion without further specification.

Ensure the tumor is confirmed benign and not a malignant carcinoid or adenocarcinoma.

Common Mistakes

HCC Buddy guidance

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.

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.025 an HCC code?

Yes. D3A.025 (Benign carcinoid tumor of the sigmoid colon) maps to Bladder, Colorectal, and Other Cancers under the CMS-HCC V28 risk adjustment model, with a community non-dual aged RAF of 0.363. It is billable for payment year 2026.

Coder answer: D3A.025 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.025
Description: Benign carcinoid tumor of the sigmoid colon
HCC (V28): HCC 22 — Bladder, Colorectal, and Other Cancers
RAF: 0.363
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 22, Bladder, Colorectal, and Other Cancers

0.363

RxHCCHCC 22, Cancer, Other Specified Sites

0.124

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work D3A.025 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for D3A.025

For D3A.025 to 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.

Coder workflow notes

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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.