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ICD-10/C7A.095

C7A.095 ICD-10-CM Code: Malignant carcinoid tumor of the midgut, unspecified

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Inpatient Payment Groups (MS-DRG)

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43.0, Appendix B.

  • MS-DRG 374 — DIGESTIVE MALIGNANCY WITH MCC (MDC 06)
  • MS-DRG 375 — DIGESTIVE MALIGNANCY WITH CC (MDC 06)
  • MS-DRG 376 — DIGESTIVE MALIGNANCY WITHOUT CC/MCC (MDC 06)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 21 — Lymphoma and Other Cancers (supersedes HCC 22, HCC 23)

Other models: CMS-HCC V22 HCC 12 · RxHCC V08 HCC 22

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Official Registry Overview & Definition

Malignant carcinoid tumor of the midgut, unspecified is a billable ICD-10-CM diagnosis code (C7A.095).

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for C7A.095 in the official ICD-10-CM tabular list.

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Code Also

Additional codes that may be required to fully describe the encounter.

  • any associated multiple endocrine neoplasia [MEN] syndromes (E31.2-)

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code to identify any associated endocrine syndrome, such as:
  • carcinoid syndrome (E34.00)

Change history

  • FY2017 — 2016-10-01
    Description revised
    Malignant carcinoid tumor of the midgut NOS → Malignant carcinoid tumor of the midgut, unspecified
    FY2017 changes
  • FY2017 — 2016-10-01
    Short description revised
    Malignant carcinoid tumor of the midgut NOS → Malignant carcinoid tumor of the midgut, unspecified
    FY2017 changes

Verify Before Coding

  • Billable — reportable as written.
  • CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim.

Contextual Map

Every relationship of C7A.095 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Hierarchy

  • C00-D49 — Chapter 2: Neoplasms (C00-D49) (C00-D49) [Hierarchy]

Referenced by Excludes1 notes

  • C75 — Malignant neoplasm of other endocrine glands and related structures [Excludes1](via C7A.-): “malignant neuroendocrine tumors (C7A.-)” · check together
  • C75 — Malignant neoplasm of other endocrine glands and related structures [Excludes1](via C7A.0.-): “malignant carcinoid tumors (C7A.0-)” · check together

Referenced by Code Also instructions

  • E34.0 — Carcinoid syndrome [Code Also](via C7A.-): “primary neuroendocrine tumors (C7A.-)” · check together

Clinical classification (CCSR)

  • NEO066 — Malignant neuroendocrine tumors [CCSR]

Risk adjustment (CMS-HCC)

  • HCC 21 — Lymphoma and Other Cancers [CMS-HCC]: “Lymphoma and Other Cancers — supersedes HCC 22 (Bladder, Colorectal, and Other Cancers), HCC 23 (Prostate, Breast, and Other Cancers and Tumors)”

Potential MS-DRG

  • CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”
  • DRG 374 — DIGESTIVE MALIGNANCY WITH MCC [MS-DRG]: “DIGESTIVE MALIGNANCY WITH MCC (MDC 06)”
  • DRG 375 — DIGESTIVE MALIGNANCY WITH CC [MS-DRG]: “DIGESTIVE MALIGNANCY WITH CC (MDC 06)”
  • DRG 376 — DIGESTIVE MALIGNANCY WITHOUT CC/MCC [MS-DRG]: “DIGESTIVE MALIGNANCY WITHOUT CC/MCC (MDC 06)”

MDC crossing · procedures (5744)

  • MDC 06 — Diseases and Disorders of the Digestive System [MDC crossing]: “Diseases and Disorders of the Digestive System — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”
  • 008Q0ZZ — Division of Vagus Nerve, Open Approach [Same-MDC procedure]: “Division of Vagus Nerve, Open Approach — grouped in MDC 06, the procedure side of this code's crossing.” · check together
  • 008Q3ZZ — Division of Vagus Nerve, Percutaneous Approach [Same-MDC procedure]: “Division of Vagus Nerve, Percutaneous Approach — grouped in MDC 06, the procedure side of this code's crossing.” · check together
  • 008Q4ZZ — Division of Vagus Nerve, Percutaneous Endoscopic Approach [Same-MDC procedure]: “Division of Vagus Nerve, Percutaneous Endoscopic Approach — grouped in MDC 06, the procedure side of this code's crossing.” · check together
  • 02BP3ZZ — Excision of Pulmonary Trunk, Percutaneous Approach [Same-MDC procedure]: “Excision of Pulmonary Trunk, Percutaneous Approach — grouped in MDC 06, the procedure side of this code's crossing.” · check together
  • 02BQ3ZZ — Excision of Right Pulmonary Artery, Percutaneous Approach [Same-MDC procedure]: “Excision of Right Pulmonary Artery, Percutaneous Approach — grouped in MDC 06, the procedure side of this code's crossing.” · check together
  • and 5739 more

Index entries

  • Tumor, carcinoid, malignant, midgut NOS[Index term]

Nearest codes (27)

  • C7A — Malignant neuroendocrine tumors [Sibling]
  • C7A.0 — Malignant carcinoid tumors [Sibling]
  • C7A.00 — Malignant carcinoid tumor of unspecified site [Sibling]
  • C7A.01 — Malignant carcinoid tumors of the small intestine [Sibling]
  • C7A.010 — Malignant carcinoid tumor of the duodenum [Sibling]
  • C7A.011 — Malignant carcinoid tumor of the jejunum [Sibling]
  • C7A.012 — Malignant carcinoid tumor of the ileum [Sibling]
  • C7A.019 — Malignant carcinoid tumor of the small intestine, unspecified portion [Sibling]
  • and 19 more

Change history (2)

  • FY2017 — Description revised [Change history]
  • and 1 more

Referenced by Other Codes

Clinical classification (AHRQ CCSR):NEO066 — Malignant neuroendocrine tumors (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Potential MS-DRG Relationships (FY2026)

CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 47 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 3 MS-DRGs: DRG 374 (MDC 06), DRG 375 (MDC 06), DRG 376 (MDC 06).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Official ICD-10-CM tabular notes on other codes that name C7A.095 or its code family.

2 Excludes1 notes: C75 (via C7A.-), C75 (via C7A.0.-).

1 Code Also instructions: E34.0 (via C7A.-).

Nearest Codes in This Family

Official ICD-10-CM classifications closest to C7A.095 in its code family, with their registry titles.

  • C7A.09 — Malignant carcinoid tumors of other sites
  • C7A.090 — Malignant carcinoid tumor of the bronchus and lung
  • C7A.091 — Malignant carcinoid tumor of the thymus
  • C7A.092 — Malignant carcinoid tumor of the stomach
  • C7A.093 — Malignant carcinoid tumor of the kidney
  • C7A.094 — Malignant carcinoid tumor of the foregut, unspecified
  • C7A.096 — Malignant carcinoid tumor of the hindgut, unspecified
  • C7A.098 — Malignant carcinoid tumors of other sites
  • C7A.1 — Malignant poorly differentiated neuroendocrine tumors
  • C7A.8 — Other malignant neuroendocrine tumors

View all codes in the C7A family

Indexed Clinical Terms (1)

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code.

  • Tumor, carcinoid, malignant, midgut NOS