ICD-10 C7B.04
Billable / Specific HCC v28: 8Secondary carcinoid tumors of peritoneum
About ICD-10-CM C7B.04
ICD-10-CM code C7B.04 represents Secondary carcinoid tumors of peritoneum. This is a billable/specific code in the Neoplasms chapter (block C7B). The 2026 edition of ICD-10-CM C7B.04 became effective on October 1, 2025.
Coding Tips for C7B.04
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
C7B.04 is a CMS-HCC v28 risk-adjustment code (category 8). 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.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under C7B.04. Per CMS ICD-10-CM Tabular 2026.
- Mesentery metastasis of carcinoid tumor
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 C7B.04
Local Coverage Determinations (LCDs) from CMS MACs that list C7B.04 as a covered diagnosis.
Showing top 10 of 526 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing C7B.04.
5 Medicare
CPT Codes Commonly Billed with C7B.04
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
Convert C7B.04 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 |
|---|---|---|
| C7B.04 | 20974 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To C7B.04
Other codes in section C7B (Secondary neuroendocrine tumors).
ICD-10 C7B.04, Billing FAQ
Is ICD-10 code C7B.04 billable? +
Yes, C7B.04 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to C7B.04? +
ICD-10 C7B.04 includes: Mesentery metastasis of carcinoid tumor.
Does C7B.04 affect Medicare Advantage HCC risk adjustment? +
Yes. C7B.04 maps to CMS-HCC v28 category 8. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with C7B.04? +
Procedures frequently paired with C7B.04 include: 88120, 86386, 86294, 86316, 88121.
What ICD-9 codes does C7B.04 map to? +
Per CMS GEMs, C7B.04 maps to ICD-9 codes: 20974. 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 May 31, 2026.
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