D3A.094
BillableBenign carcinoid tumor of the foregut, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D3A.094 an HCC code?
Yes. D3A.094 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.094
For D3A.094to 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.
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 community, non-dual, aged base RAF weight of 0.363. D3A.094 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.
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 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.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.