D3A.026
BillableBenign carcinoid tumor of the rectum
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D3A.026 an HCC code?
Yes. D3A.026 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.026
For D3A.026to 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.026 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D3A.026 is the ICD-10-CM diagnosis code for benign carcinoid tumor of the rectum. A benign neuroendocrine tumor located in the rectum, the final section of the large intestine before the anus. D3A.026 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.026 maps to Bladder, Colorectal, and Other Cancers (HCC 22) with a community, non-dual, aged base RAF weight of 0.363. D3A.026 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.
Ensure the tumor is documented as rectal to distinguish from other colorectal sites. Because D3A.026 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.026 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure the tumor is documented as rectal to distinguish from other colorectal sites
- •Note that rectal carcinoid tumors are relatively common and may be found incidentally
Clinical Significance
Benign carcinoid tumors of the rectum are among the most common gastrointestinal neuroendocrine neoplasms, frequently discovered incidentally during colonoscopy or rectal examination. Most rectal carcinoids are small, localized, and carry an excellent prognosis with endoscopic resection alone when confirmed benign.
Documentation Requirements
- ✓Documentation should specify the rectal location, confirmed by endoscopic or surgical pathology.
- ✓Tumor size is critical as it influences management: lesions under 1 centimeter have minimal metastatic potential.
- ✓The pathology must confirm benign behavior, and endoscopic ultrasound findings regarding depth of invasion should be documented when performed.
Commonly Confused Codes
- •C7A.026 (malignant carcinoid of rectum) is used when the pathology confirms malignant features.
- •D3A.025 (benign carcinoid of sigmoid colon) involves the adjacent anatomical segment.
- •D12.8 (benign neoplasm of rectum) is used for non-neuroendocrine benign tumors such as adenomatous polyps.