D3A.092
BillableBenign carcinoid tumor of the stomach
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D3A.092 an HCC code?
Yes. D3A.092 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.092
For D3A.092to 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.092 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D3A.092 is the ICD-10-CM diagnosis code for benign carcinoid tumor of the stomach. A benign, slow-growing hormone-producing tumor of the stomach that may cause abdominal symptoms or be found during endoscopy. D3A.092 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.092 maps to Bladder, Colorectal, and Other Cancers (HCC 22) with a community, non-dual, aged base RAF weight of 0.363. D3A.092 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.
Document the specific location within the stomach (fundus, body, antrum) if available for more precise coding. Because D3A.092 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.092 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific location within the stomach (fundus, body, antrum) if available for more precise coding
- •Verify the tumor is benign and not a gastric neuroendocrine carcinoma (C16.9) based on pathology findings
Clinical Significance
Benign carcinoid tumors of the stomach (gastric carcinoids) represent a spectrum of neuroendocrine neoplasms that are increasingly identified during upper endoscopy. Type I gastric carcinoids (associated with chronic atrophic gastritis) are the most common and have an excellent prognosis, while types II and III carry different risk profiles that may affect behavior classification.
Documentation Requirements
- ✓Documentation must specify the gastric location and the type of gastric carcinoid (Type I, II, or III) when available, as each has different clinical implications.
- ✓Pathology should confirm benign behavior, neuroendocrine markers, tumor size, and gastrin levels if relevant.
- ✓Endoscopic ultrasound findings regarding depth of invasion should be included.