D3A.098
BillableBenign carcinoid tumors of other sites
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D3A.098 an HCC code?
Yes. D3A.098 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.098
For D3A.098to 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.098 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D3A.098 is the ICD-10-CM diagnosis code for benign carcinoid tumors of other sites. A benign hormone-producing tumor located in sites other than the common neuroendocrine tumor locations (such as the pancreas, ovary, or other organs). D3A.098 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.098 maps to Bladder, Colorectal, and Other Cancers (HCC 22) with a community, non-dual, aged base RAF weight of 0.363. D3A.098 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 anatomical site clearly in the medical record for accurate coding assignment. Because D3A.098 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.098 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific anatomical site clearly in the medical record for accurate coding assignment
- •Review the pathology report to confirm benign behavior and neuroendocrine differentiation
Clinical Significance
This code captures benign carcinoid tumors arising at anatomical sites not covered by other specific D3A codes, such as the pancreas, ovary, testis, or other uncommon locations. These tumors are rare and may exhibit unique hormonal profiles depending on their site of origin, requiring specialized pathologic evaluation.
Documentation Requirements
- ✓Documentation must specify the anatomical site and confirm neuroendocrine differentiation with benign behavior on pathology.
- ✓Immunohistochemical staining results (chromogranin A, synaptophysin) should be documented.
- ✓Any functional hormone secretion should be noted along with relevant laboratory values.
Commonly Confused Codes
- •C7A.098 (malignant carcinoid of other sites) is the malignant counterpart.
- •Site-specific benign neoplasm codes (such as D13.6 for benign neoplasm of pancreas) may be appropriate if the tumor lacks neuroendocrine differentiation.
- •D3A.8 (other benign neuroendocrine tumors) is used for non-carcinoid neuroendocrine tumors.