What is ICD-10 code D3A.026?

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. It belongs to the ICD-10-CM chapter for neoplasms (c00-d49). D3A.026 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. D3A.026 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.026 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.026 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.026 map to under V28?

D3A.026 maps to CMS-HCC V28 HCC 22 (Bladder, Colorectal, and Other Cancers). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM D3A.026: Benign carcinoid tumor

D3A.026 maps to CMS-HCC V28 22. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software

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Code lookupD3A.026

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

D3A.026

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

Benign carcinoid tumor of the rectum

A benign neuroendocrine tumor located in the rectum, the final section of the large intestine before the anus.

Buddy Insight

Benign carcinoid tumors of the rectum are among the most common gastrointestinal neuroendocrine neoplasms, frequently discovered incidentally during colonoscopy or rectal examination.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 22

Bladder, Colorectal, and Othe...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

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

Prostate, Breast, Bladder, an...

Code-level coefficient reference

Code Book Path

Official

D3A.0Benign carcinoid tumors D3A.02Benign carcinoid tumors of the appendix, large intestine, and rectum D3A.026Benign carcinoid tumor of the rectum

Inclusion Terms

Official

No inclusion terms are included in this display for D3A.026. Check the code and parent instructions in the Code Book.

Excludes 2

Official

benign pancreatic islet cell tumors (D13.7)Inherited from D3A

Related 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

No Includes notes are included in this display for D3A.026. Check the code and parent instructions in the Code Book.

Excludes 1

Official

No Excludes 1 notes are included in this display for D3A.026. Check the code and parent instructions in the Code Book.

Code First

Official

No Code First sequencing instructions are included in this display for D3A.026. Check the code and parent instructions in the Code Book.

Use Additional

Official

code to identify any associated endocrine syndrome, such as:Inherited from D3A
carcinoid syndrome (E34.00)Inherited from D3A

Code Also

Official

any associated multiple endocrine neoplasia [MEN] syndromes (E31.2-)Inherited from D3A

Buddy Documentation Tip

HCC Buddy guidance

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.

MEAT Support

HCC Buddy guidance

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.

Audit Caution

HCC Buddy guidance

Rectal carcinoids are relatively common, so it is important to verify that the pathology confirms neuroendocrine differentiation rather than an adenoma or other benign neoplasm.

Do not confuse with rectosigmoid tumors that may require a different code.

Always confirm benign versus malignant behavior on the pathology report before code assignment.

Common Mistakes

HCC Buddy guidance

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.

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.026 an HCC code?

Yes. D3A.026 (Benign carcinoid tumor of the rectum) maps to HCC 22, Bladder, Colorectal, and Other Cancers under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.363. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: D3A.026 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.026
Description: Benign carcinoid tumor of the rectum
HCC (V28): HCC 22 — Bladder, Colorectal, and Other Cancers
RAF reference coefficient: 0.363
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 22, Bladder, Colorectal, and Other Cancers

0.363

RxHCCHCC 22, Prostate, Breast, Bladder, and Other Cancers and Tumors

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work D3A.026 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for D3A.026

For D3A.026, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

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

Coder workflow notes

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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 source-labeled community, non-dual, aged reference coefficient of 0.363. No V24 mapping is shown for D3A.026; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Ensure the tumor is documented as rectal to distinguish from other colorectal sites. For D3A.026, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, 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.