D49.1 ICD-10-CM Code: Neoplasm of unspecified behavior of respiratory system
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FY 2026 Apr update / Neoplasms (C00-D49) / Neoplasms of unspecified behavior (D49)
D49.1
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceNeoplasm of unspecified behavior of respiratory system
A tumor or growth of unknown behavior found in the respiratory system (including the lungs, trachea, or bronchi).
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for D49.1 in this effective period.
Excludes 2
Official- neoplasms of uncertain behavior (D37-D44, D48)
Related Child Codes
Includes
Official- 'growth' NOS
- neoplasm NOS
- new growth NOS
- tumor NOS
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for D49.1 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for D49.1 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for D49.1 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for D49.1 in this effective period.
Buddy Documentation Tip
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.
Is D49.1 an HCC code?
No. D49.1 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
D49.1 is the ICD-10-CM diagnosis code for neoplasm of unspecified behavior of respiratory system. A tumor or growth of unknown behavior found in the respiratory system (including the lungs, trachea, or bronchi). D49.1 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering neoplasms of unspecified behavior (d49).
D49.1 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Document the specific respiratory organ involved (lung, trachea, larynx) when available for more precise coding.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for D49.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific respiratory organ involved (lung, trachea, larynx) when available for more precise coding
- •Coordinate with pathology and radiology reports to clarify the nature and behavior of the respiratory lesion