ICD-10 C7A.026
Billable / Specific HCC v28: 12Malignant carcinoid tumor of the rectum
About ICD-10-CM C7A.026
ICD-10-CM code C7A.026 represents Malignant carcinoid tumor of the rectum. This is a billable/specific code in the Neoplasms chapter (block C7A). The 2026 edition of ICD-10-CM C7A.026 became effective on October 1, 2025.
Coding Tips for C7A.026
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
C7A.026 is a CMS-HCC v28 risk-adjustment code (category 12). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Medicare LCD Coverage for C7A.026
Local Coverage Determinations (LCDs) from CMS MACs that list C7A.026 as a covered diagnosis.
Showing top 10 of 877 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing C7A.026.
5 Medicare
CPT Codes Commonly Billed with C7A.026
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 88120 CMS LCD: Billing and Coding: Lab: Bladder/Urothelial Tumor Markers CMS LCD
- 86386 CMS LCD: Billing and Coding: Lab: Bladder/Urothelial Tumor Markers CMS LCD
- 86294 CMS LCD: Billing and Coding: Lab: Bladder/Urothelial Tumor Markers CMS LCD
- 86316 CMS LCD: Billing and Coding: Lab: Bladder/Urothelial Tumor Markers CMS LCD
- 88121 CMS LCD: Billing and Coding: Lab: Bladder/Urothelial Tumor Markers CMS LCD
- J2353 CMS LCD: Billing and Coding: Octreotide Acetate for Injectable Suspension (Sandostatin� LAR Depot) CMS LCD
Convert C7A.026 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| C7A.026 | 20917 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To C7A.026
Other codes in section C7A (Malignant neuroendocrine tumors).
ICD-10 C7A.026, Billing FAQ
Is ICD-10 code C7A.026 billable? +
Yes, C7A.026 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does C7A.026 affect Medicare Advantage HCC risk adjustment? +
Yes. C7A.026 maps to CMS-HCC v28 category 12. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with C7A.026? +
Procedures frequently paired with C7A.026 include: 88120, 86386, 86294, 86316, 88121.
What ICD-9 codes does C7A.026 map to? +
Per CMS GEMs, C7A.026 maps to ICD-9 codes: 20917. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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