What is ICD-10 code D3A.094?

D3A.094 is the ICD-10-CM diagnosis code for Benign carcinoid tumor of the foregut, unspecified. A benign hormone-producing tumor arising from the foregut (esophagus, stomach, or duodenum) when the specific site cannot be determined. It belongs to the ICD-10-CM chapter for neoplasms (c00-d49). D3A.094 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. D3A.094 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.094 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.094 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.094 map to under V28?

D3A.094 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.

What documentation supports D3A.094?

Use this code only when the exact foregut location cannot be specified; attempt to obtain more specific anatomical information from pathology Foregut carcinoids are more likely to produce serotonin and cause carcinoid syndrome compared to other sites Because D3A.094 maps to an HCC category, the documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. MEAT is generic documentation evidence, not a payer-specific rule.

2026 ICD-10-CM D3A.094: Benign carcinoid tumor

D3A.094 maps to CMS-HCC V28 22. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC Buddy coding tools

ICD-10-CM Code View

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Code lookupD3A.094Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

D3A.094

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

Benign carcinoid tumor of the foregut, unspecified

A benign hormone-producing tumor arising from the foregut (esophagus, stomach, or duodenum) when the specific site cannot be determined.

Buddy Insight

This code captures benign carcinoid tumors arising from foregut structures (esophagus, stomach, duodenum, and proximal jejunum) when the specific site cannot be identified.

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.09Benign carcinoid tumors of other sites

D3A.094Benign carcinoid tumor of the foregut, unspecified

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for D3A.094 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for D3A.094 in this effective period.

Related Child Codes

Official

D3A.090Benign carcinoid tumor of the bronchus and lung

D3A.091Benign carcinoid tumor of the thymus

D3A.092Benign carcinoid tumor of the stomach

D3A.093Benign carcinoid tumor of the kidney

D3A.095Benign carcinoid tumor of the midgut, unspecified

Includes

Official

ICD-10-CM does not list Includes notes for D3A.094 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for D3A.094 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for D3A.094 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for D3A.094 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for D3A.094 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

This code should only be used when the specific foregut site cannot be determined from available documentation.

A provider query should be initiated to obtain the precise anatomical location from endoscopy, imaging, or surgical pathology.

Any hormonal syndromes or associated conditions should be documented.

MEAT Support

HCC Buddy guidance

This code should only be used when the specific foregut site cannot be determined from available documentation.

A provider query should be initiated to obtain the precise anatomical location from endoscopy, imaging, or surgical pathology.

Any hormonal syndromes or associated conditions should be documented.

Audit Caution

HCC Buddy guidance

Always attempt to identify the specific foregut site before defaulting to this unspecified code.

The foregut designation should be based on embryologic origin, not just upper gastrointestinal location.

Verify pathology confirms benign behavior, as foregut carcinoids can occasionally be more aggressive than their counterparts.

Common Mistakes

HCC Buddy guidance

D3A.092 (benign carcinoid of stomach) and other site-specific foregut carcinoid codes should be used when the exact location is documented.

D3A.095 (benign carcinoid of midgut, unspecified) is used for tumors in the distal jejunum through ascending colon.

C7A.094 (malignant carcinoid of foregut) is the malignant counterpart.

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.094 an HCC code?

Yes. D3A.094 (Benign carcinoid tumor of the foregut, unspecified) 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.094 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.094
Description: Benign carcinoid tumor of the foregut, unspecified
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.094 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for D3A.094

For D3A.094 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.094 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

D3A.094 is the ICD-10-CM diagnosis code for benign carcinoid tumor of the foregut, unspecified. A benign hormone-producing tumor arising from the foregut (esophagus, stomach, or duodenum) when the specific site cannot be determined. D3A.094 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.094 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.094; use the applicable model and payment year when reviewing the V28 mapping. 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. 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.

Use this code only when the exact foregut location cannot be specified; attempt to obtain more specific anatomical information from pathology. Because D3A.094 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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.094 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use this code only when the exact foregut location cannot be specified; attempt to obtain more specific anatomical information from pathology
•Foregut carcinoids are more likely to produce serotonin and cause carcinoid syndrome compared to other sites

Clinical Significance

This code captures benign carcinoid tumors arising from foregut structures (esophagus, stomach, duodenum, and proximal jejunum) when the specific site cannot be identified. Foregut carcinoids have unique features including potential for atypical hormone secretion and association with Zollinger-Ellison syndrome or Multiple Endocrine Neoplasia syndromes.

Documentation Requirements

✓This code should only be used when the specific foregut site cannot be determined from available documentation.
✓A provider query should be initiated to obtain the precise anatomical location from endoscopy, imaging, or surgical pathology.
✓Any hormonal syndromes or associated conditions should be documented.

Commonly Confused Codes

•D3A.092 (benign carcinoid of stomach) and other site-specific foregut carcinoid codes should be used when the exact location is documented.
•D3A.095 (benign carcinoid of midgut, unspecified) is used for tumors in the distal jejunum through ascending colon.
•C7A.094 (malignant carcinoid of foregut) is the malignant counterpart.