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D3A.095 ICD-10-CM Code: Benign 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 393 — OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC (MDC 06)
  • MS-DRG 394 — OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC (MDC 06)
  • MS-DRG 395 — OTHER DIGESTIVE SYSTEM DIAGNOSES 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 22 — Bladder, Colorectal, and Other Cancers (supersedes HCC 23)

Other models: 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.

Code Overview

Benign carcinoid tumor of the midgut, unspecified is a billable ICD-10-CM diagnosis code (D3A.095).

Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for D3A.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: inherited from D3A
  • carcinoid syndrome (E34.00) inherited from D3A

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, benign, midgut NOS

Frequently Compared Codes

The official Excludes notes on D3A.095 name these codes. Each comparison page covers when the two can — or must not — be reported together.

Change history

  • FY2017 — 2016-10-01
    Description revised
    Benign carcinoid tumor of the midgut NOS → Benign carcinoid tumor of the midgut, unspecified
    FY2017 changes
  • FY2017 — 2016-10-01
    Short description revised
    Benign carcinoid tumor of the midgut NOS → Benign carcinoid tumor of the midgut, unspecified
    FY2017 changes
  • FY2016 — 2015-10-01
    In the code set at ICD-10-CM adoption
    Benign carcinoid tumor of the midgut NOS

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

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

Relationships & Classification

Potential MS-DRG Relationships (FY2026)

Not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity.

Named in the grouper logic of 3 MS-DRGs: DRG 393 (MDC 06), DRG 394 (MDC 06), DRG 395 (MDC 06).

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

Clinical classification (AHRQ CCSR):NEO073 — Benign neoplasms (default).

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

Related Codes

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Bladder, Colorectal, and Other Cancers) for risk-adjusted payment.

D3A.010 — Benign carcinoid tumor of the duodenum, D3A.011 — Benign carcinoid tumor of the jejunum, D3A.012 — Benign carcinoid tumor of the ileum, D3A.019 — Benign carcinoid tumor of the small intestine, unspecified portion, D3A.020 — Benign carcinoid tumor of the appendix, D3A.021 — Benign carcinoid tumor of the cecum, D3A.022 — Benign carcinoid tumor of the ascending colon, D3A.023 — Benign carcinoid tumor of the transverse colon, D3A.024 — Benign carcinoid tumor of the descending colon, D3A.025 — Benign carcinoid tumor of the sigmoid colon, D3A.026 — Benign carcinoid tumor of the rectum, D3A.029 — Benign carcinoid tumor of the large intestine, unspecified portion, D3A.090 — Benign carcinoid tumor of the bronchus and lung, D3A.091 — Benign carcinoid tumor of the thymus, D3A.092 — Benign carcinoid tumor of the stomach, D3A.093 — Benign carcinoid tumor of the kidney, D3A.094 — Benign carcinoid tumor of the foregut, unspecified, D3A.096 — Benign carcinoid tumor of the hindgut, unspecified, D3A.098 — Benign carcinoid tumors of other sites, D3A.8 — Other benign neuroendocrine tumors, +105 more

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Lymphoma and Other Cancers, Lung and Other Severe Cancers, Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers, Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid, Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic, Prostate, Breast, and Other Cancers and Tumors

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Benign neoplasms).

D3A.012 — Benign carcinoid tumor of the ileum, D3A.019 — Benign carcinoid tumor of the small intestine, unspecified portion, D3A.020 — Benign carcinoid tumor of the appendix, D3A.021 — Benign carcinoid tumor of the cecum, D3A.022 — Benign carcinoid tumor of the ascending colon, D3A.023 — Benign carcinoid tumor of the transverse colon, D3A.024 — Benign carcinoid tumor of the descending colon, D3A.025 — Benign carcinoid tumor of the sigmoid colon, D3A.026 — Benign carcinoid tumor of the rectum, D3A.029 — Benign carcinoid tumor of the large intestine, unspecified portion, D3A.090 — Benign carcinoid tumor of the bronchus and lung, D3A.091 — Benign carcinoid tumor of the thymus, D3A.092 — Benign carcinoid tumor of the stomach, D3A.093 — Benign carcinoid tumor of the kidney, D3A.094 — Benign carcinoid tumor of the foregut, unspecified, D3A.096 — Benign carcinoid tumor of the hindgut, unspecified, D3A.098 — Benign carcinoid tumors of other sites, D3A.8 — Other benign neuroendocrine tumors, K31.7 — Polyp of stomach and duodenum, K63.5 — Polyp of colon, +252 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Iron Panel

Contextual Map

Every relationship of D3A.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]

Clinical classification (CCSR)

  • NEO073 — Benign neoplasms [CCSR]

Risk adjustment (CMS-HCC)

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

Potential MS-DRG

  • DRG 393 — OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC [MS-DRG]: “OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC (MDC 06)”
  • DRG 394 — OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC [MS-DRG]: “OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC (MDC 06)”
  • DRG 395 — OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC [MS-DRG]: “OTHER DIGESTIVE SYSTEM DIAGNOSES 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, benign, midgut NOS[Index term]

Nearest codes (26)

  • D3A — Benign neuroendocrine tumors [Sibling]
  • D3A.0 — Benign carcinoid tumors [Sibling]
  • D3A.00 — Benign carcinoid tumor of unspecified site [Sibling]
  • D3A.01 — Benign carcinoid tumors of the small intestine [Sibling]
  • D3A.010 — Benign carcinoid tumor of the duodenum [Sibling]
  • D3A.011 — Benign carcinoid tumor of the jejunum [Sibling]
  • D3A.012 — Benign carcinoid tumor of the ileum [Sibling]
  • D3A.019 — Benign carcinoid tumor of the small intestine, unspecified portion [Sibling]
  • and 18 more

Change history (3)

  • FY2017 — Description revised [Change history]
  • and 2 more

Nearest Codes in This Family

Official ICD-10-CM classifications closest to D3A.095 in its code family, with their registry titles.

  • D3A.029 — Benign carcinoid tumor of the large intestine, unspecified portion
  • D3A.09 — Benign carcinoid tumors of other sites
  • D3A.090 — Benign carcinoid tumor of the bronchus and lung
  • D3A.091 — Benign carcinoid tumor of the thymus
  • D3A.092 — Benign carcinoid tumor of the stomach
  • D3A.093 — Benign carcinoid tumor of the kidney
  • D3A.094 — Benign carcinoid tumor of the foregut, unspecified
  • D3A.096 — Benign carcinoid tumor of the hindgut, unspecified
  • D3A.098 — Benign carcinoid tumors of other sites
  • D3A.8 — Other benign neuroendocrine tumors

View all codes in the D3A family