Coding corner update: Improve medical record documentation for lymphoma cancer

Beginning Oct. 1, 2015, the transition to ICD-10-CM will affect every area of health care. Many codes contain much greater specificity. In the next few issues of The Record, you’ll find a series of revised “Coding corner” articles that include updated codes to align with the transition to ICD-10-CM.

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-10-CM categories C81-C88.

• 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 areas 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 C81-C88. 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 Z85.7. Personal history of other malignant neoplasms of lymphoid, hematopoietic and related issues The codes in this category are based on the type of lymphoma documented such as Hodgkin lymphoma, Non-Hodgkin lymphomas or other malignant neoplasms of lymphoid, hematopoietic and related tissues.
• 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 C00-C80.

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 category C81in ICD-10-CM.
  
  Category C81 provides a 4th character subcategory to identify the pathologic subtype of Hodgkin’s lymphoma and a 5th character that identifies the lymph nodes affected.
  
  The Hodgkin lymphoma pathologic subtype is identified in the following subcategories:
  C81.0 Nodular lymphocyte predominant Hodgkin lymphoma
  C81.1 Nodular sclerosis classical Hodgkin lymphoma
  C81.2 Mixed cellularity classical Hodgkin lymphoma
  C81.3 Lymphocyte depleted classical Hodgkin lymphoma
  C81.4 Lymphocyte-rich classical Hodgkin lymphoma
  C81.7 Other classical Hodgkin lymphoma
  C81.9 Hodgkin lymphoma, 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. Information required to correctly code this condition includes, but is not limited to location, grade, and follicular information. ICD-10-CM provides the following categories for non-Hodgkin lymphomas:
  
  C82 Follicular lymphoma
  C83 Non-follicular lymphoma
  C84 Mature T/NK-cell lymphomas
  C85 Other specified and unspecified types of non-Hodgkin lymphoma
  C86 Other specified types of T/NK-cell lymphoma
  C88 Malignant immunoproliferative disease and certain other B-cell lymphoma

Locating lymphoma codes and digit clarification
Begin searching for the appropriate code in the alphabetical index under lymphoma. For benign lymphomas please reference the neoplasm table. In the table, reference the site of the neoplasm and select the code from the benign column. Many sites are coded to D36.0.

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

0 – Unspecified site,
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
9 – Extranodal and solid organ sites

Lymphomas need to be coded to the highest level of specificity. Refer to your ICD-10-CM guidelines for more specific information on the differences between benign and malignant.

ICD-10-CM coding for all conditions should always follow coding conventions, chapter specific guidelines and general coding guidelines.

If you have questions or need more information, contact your provider consultant.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with applicable state and federal laws and regulations.