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D49 ICD-10-CM Code: Neoplasms of unspecified behavior

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FY 2026 Apr update / Neoplasms (C00-D49) / Neoplasms of unspecified behavior (D49)

D49

Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidance

Neoplasms of unspecified behavior

Neoplasms of unspecified behavior

CMS-HCC V28

0

0

RAF 0

CMS-HCC V24

0

0

RAF 0

ACA/HHS

0

0

RAF 0

ESRD/PACE

0

0

RAF 0

RXHCC

0

0

RAF 0

Code Trumping

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Code Book Path

Official
D4Neoplasms of unspecified behavior (D49)
D49Neoplasms of unspecified behavior

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for D49 in this effective period.

Excludes 2

Official
  • neoplasms of uncertain behavior (D37-D44, D48)

Related Child Codes

Official
D49.0Neoplasm of unspecified behavior of digestive system
D49.1Neoplasm of unspecified behavior of respiratory system
D49.2Neoplasm of unspecified behavior of bone, soft tissue, and skin
D49.3Neoplasm of unspecified behavior of breast
D49.4Neoplasm of unspecified behavior of bladder

Includes

Official
  • 'growth' NOS
  • neoplasm NOS
  • new growth NOS
  • tumor NOS

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for D49 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for D49 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for D49 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for D49 in this effective period.

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

What This Code Means

D49 is the ICD-10-CM diagnosis code for neoplasms of unspecified behavior. D49 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering neoplasms of unspecified behavior (d49).

Header codes like D49 cannot be reported on claims directly, they organize child codes that share clinical context but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at D49's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for D49 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Includes

  • 'growth' NOS
  • neoplasm NOS
  • new growth NOS
  • tumor NOS

Excludes 2, Not included here, may code separately

  • neoplasms of uncertain behavior (D37-D44, D48)

Child Codes

Code Hierarchy

D49Neoplasms of unspecified behavior
D49Neoplasms of unspecified behavior

More on D49

Referenced in blog posts

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