Keep these coding tips in mind to improve medical record documentation

Lymphoma cancer is often coded incorrectly due to misconceptions about the nature of the condition. To be classified as lymphoma, the neoplasm must originate within the lymph nodes. This is different than a solid tumor that has spread to the lymph nodes.

Tips to consider when coding lymphoma
Proper documentation is the key to accurate code selection for lymphomas. If documentation is unclear, ask the physician for more explanation to ensure codes chosen are to the highest level of specificity. Coding for neoplasms classified as lymphomas can be found in ICD-9-CM categories 200-202.

• A malignant neoplasm must form within the lymph nodes to be classified as lymphoma.
• Neoplasms that form in the lymphatic and hematopoietic tissues do not spread to secondary sites. Rather, the malignant cells may travel and arise in other sites within the associated tissues. These are still classified as primary neoplasms.
• Lymphomas can be benign or malignant; this should be specifically identified in the physician’s documentation.
• When a physician documents that the lymphoma is "in remission," it is still reported using lymphoma codes 200-202. Although the condition is in remission, it is still classified as an active condition.
• If the lymphoma is documented as "history of," indicating the condition is completely cured, select a personal history code from category V10.7X. There are three different V codes based on the type of lymphoma documented.
• Solid tumors that have spread or metastasized to the lymph nodes are not considered lymphoma. They are considered secondary or unspecified malignant neoplasms of the lymph nodes and are reported with categories 140-199.

Types of lymphoma
Lymphoma is most commonly referenced by two specific types: Hodgkin lymphoma and non-Hodgkin lymphoma. The type of lymphoma is determined by how it behaves, spreads and responds to treatment.

• Hodgkin lymphoma
  Hodgkin lymphoma is an uncommon form of lymphoma involving Reed-Sternberg Cells, large abnormal lymphocytes that may contain more than one nuclei. Most are of B-cell origin. Typically, this lymphoma begins in a single node and spreads to other nodes. Hodgkin lymphoma is commonly classified to the following codes. An "X" in the fifth place indicates a fifth digit is required.

  201.0X - Hodgkin paragranuloma
  201.1X - Hodgkin granuloma
  201.2X - Hodgkin sarcoma
  201.4X - Lymphocytic-histiocytic predominance
  201.5X - Nodular sclerosis
  201.6X - Mixed cellularity
  201.7X - Lymphocytic depletion
  201.9X - Hodgkin disease, unspecified
  

• Non-Hodgkin lymphoma
  There are many different classifications and sub-types of non-Hodgkin lymphoma. To ensure the most specific code is reported, providers should document the most specific subtype of non-Hodgkin lymphoma. Listed below are a few of the more common codes for non-Hodgkin lymphoma. An X in the fifth place indicates a fifth digit is required.

  200.0X - Reticulosarcoma
  200.1X - Lymphocarcoma
  200.2X - Burkitt’s tumor or lymphoma
  200.3X - Marginal zone lymphoma
  200.4X - Mantle cell lymphoma
  200.5X - Primary central nervous system lymphoma
  200.6X - Anaplastic large cell lymphoma
  200.7X - Large cell lymphoma
  202.0X - Nodular lymphoma
  202.1X - Mycosis fungoides
  202.2X - Sezary’s disease
  202.7X - Peripheral T-cell lymphoma
  202.8X - Other lymphomas

Locating lymphoma codes and digit clarification
Begin searching for the appropriate code in the alphabetical index under lymphoma. For benign lymphomas, the index will direct coders to the neoplasm table. In the table, reference the site of the neoplasm and select the code from the benign column.

When coding for a malignant neoplasm, reference the sub-term for the site or type, under lymphoma. Once a code is selected, reference the tabular list to ensure the code is correct.

A fifth digit is required for lymphomas, classifying the specific nodes and locations affected. When multiple lymph nodes are affected, the use of the fifth digit eight is utilized. The table below is a breakdown of required fifth digits.

0 - Unspecified site, extranodal and solid organ sites
1 - Lymph nodes of head, face and neck
2 - Intrathoracic lymph nodes
3 - Intra abdominal lymph nodes
4 - Lymph nodes of axilla and upper limb
5 - Lymph nodes of inguinal region and lower limb
6 - Intrapelvic lymph nodes
7 - Spleen
8 - Lymph nodes of multiple sites

Lymphomas need to be coded to the highest level of specificity. Refer to your ICD-9 guidelines for more specific information on the differences between benign and malignant.