E34.01
BillableCarcinoid heart syndrome
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E34.01 an HCC code?
Yes. E34.01 maps to Metastatic Cancer and Acute Leukemia under the CMS-HCC V28 risk adjustment model (and Breast, Prostate, and Other Cancers and Tumors under V24).
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 E34.01
For E34.01 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 E34.01 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E34.01 is the ICD-10-CM diagnosis code for carcinoid heart syndrome. Carcinoid heart syndrome is a condition where hormone-secreting tumors cause damage to the heart valves, leading to valve dysfunction. E34.01 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering disorders of other endocrine glands (e20-e35).
Under the CMS-HCC V28 risk adjustment model, E34.01 maps to Metastatic Cancer and Acute Leukemia (HCC 17) with a community, non-dual, aged base RAF weight of 0.368. Under the older CMS-HCC V24 model, E34.01 maps to Breast, Prostate, and Other Cancers and Tumors (HCC 12) with a community, non-dual, aged base RAF weight of 0.150. 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.
This code indicates carcinoid syndrome with cardiac involvement; document the specific valve(s) affected if possible. Because E34.01 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 E34.01 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code indicates carcinoid syndrome with cardiac involvement; document the specific valve(s) affected if possible
- •May require additional codes for the underlying carcinoid tumor and any resulting heart valve disease
Clinical Significance
Carcinoid heart syndrome is a serious complication of carcinoid syndrome where serotonin and other vasoactive substances cause fibrotic damage to heart valves, predominantly affecting the right side (tricuspid and pulmonic valves). This leads to progressive valvular regurgitation or stenosis and can result in right-sided heart failure, making it a major determinant of morbidity and mortality in carcinoid patients.
Documentation Requirements
- ✓Documentation must include echocardiographic findings demonstrating valve thickening, retraction, or regurgitation consistent with carcinoid heart disease.
- ✓Specify which valves are affected and the severity of valve dysfunction.
- ✓Biochemical markers (5-hydroxyindoleacetic acid, chromogranin A, N-terminal pro-brain natriuretic peptide) and the underlying neuroendocrine tumor location and stage should be documented.
- ✓Heart failure status and functional class should be noted.