Documentation Dispatch: Coding Lymphoma

Documentation Dispatch: Coding Lymphoma

  • 14 Dec Off
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By Susan Trapuzzano, RN, CPC, CRC 

Lymphoma is a type of blood cancer originating from the lymphatic system. Lymphomas are classified into two main categories, Hodgkin’s and non-Hodgkin’s lymphoma.

Hodgkin’s lymphoma affects the lymph nodes or extranodal lymphoid tissues, such as stomach, spleen, lung, bone and skin.  Most often, this disease originates in a lymph node and spreads to adjacent nodes or to extranodal tissue via the lymphatic system. The most common symptoms are often painless, enlarged lymph nodes (neck, armpits or groins) with other general symptoms such as fatigue, night sweats, fever, chills, and persistent fatigue. Hodgkin’s lymphoma is typically seen between the ages of 20 to 40 and beyond 60 years.

Hodgkin’s lymphoma is classified into 4 subtypes:

  • Nodular sclerosis
  • Mixed cellularity
  • Lymphocyte-depleted
  • Lymphocyte-rich

Non-Hodgkin’s lymphoma is a cancer with tumors that develop from an overabundance of lymphocytes (a type of white blood cell). Common symptoms are painless swollen lymph nodes (neck, armpits or groins) with other general symptoms such as fatigue, fever, sweating or chills especially at night. There are many subtypes of Non-Hodgkin’s lymphoma, with the most common being diffuse large B-cell lymphoma and follicular lymphoma. Non-Hodgkin’s lymphoma is diagnosed through physical exam, imaging tests, biopsies and bone marrow aspiration.

Lymphomas are classified to ICD-10-CM diagnosis codes C81 – C96. ICD-10 requires more specificity with documentation. The specific code assignment is based on the following documentation:

  • Type of lymphoma (Hodgkin’s, Non-Hodgkin’s, Follicular Lymphoma, Mantle Cell Lymphoma, etc.)
  • Acuity (acute, chronic, in remission)
  • Location (node or organ)

Lymphomas do not spread beyond the lymphatic system.   “Lymphomas are systemic diseases that do not metastasize in the same way that solid tumors do…a lymphoma regardless of number sites (nodes or organs), is not considered metastatic.” (AHA Coding Clinic, second quarter, page 3). Therefore, the code assignment would remain in category C81-C96.

When coding a lymphoma documented as ‘in remission,’ coders assign the appropriate code from categories C81-C96.  AHA Coding Clinic (ICD-9 CM, 1992, second quarter, page 3) states “lymphoma patients who are in remission are still considered to have lymphoma and should be assigned the appropriate code.”

Some lymphomas may be cured, especially Hodgkin’s lymphoma. In that case, the ICD-10 code would come from the Z chapter for personal history of lymphoma (Z85.7-). However, many providers confuse remission for cure and may not document clearly, requiring follow-up queries. Lymphomas are different from solid cancers, so clinically most lymphomas will be “in remission” and thus code-able in the C81-C96 categories.

Properly documenting lymphoma is important and necessary to assign the correct code. Thorough and accurate documentation is evidence that the physician provided appropriate care and that it was medically necessary.  Clinical documentation should always support the ICD-10 CM code.