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CMS End of Flexibility 10.1.2016 Mapping ICD-10 to SNOMED CT Sickle cell disease Leukemia
Cell typing FAB classifications
Lymphoma Multiple Myeloma Bone Marrow and Stem Cell Transplant
hematopoietic progenitor cell Bone marrow biopsy and aspiration GVHD
In new guidance released
8.22.2016 , CMS said that it “will
not extend ICD-10 flexibilities
beyond October 1, 2016..will be no
additional flexibility guidance.
Q&A, CMS said that providers can
prepare themselves for the end of
flexibilities by “avoiding
unspecified ICD-10 codes whenever
documentation supports a more
detailed code
ICD-10 cm flexibilities were solely
for the purpose of contractors
performing medical review so that
they would not deny claims solely
for the specificity of the ICD-10
code as long as there is no
evidence of fraud.
As of October 1, 2016, providers
will be required to code accurately,
to reflect the clinical
documentation in as much
specificity as possible, as per the
required coding guidelines,” CMS
said in the updated guidance.
https://www.cms.gov/Medicare/Coding/ICD10/Clarifying-Questions-and-Answers-Related-to-the-July-6-2015-CMS-AMA-Joint-Announcement.pdf
4
Conveying and sharing the statistical composition of our patient population
on the same level of specificity with the rest of the world
CMS End of Flexibility10.01.2016
How do you get ready for the end of flexibilities?
Avoid unspecified ICD-10 codes whenever documentation supports a more detailed code. Check the coding on each claim to make sure that it aligns with the clinical documentation.
A complete list of the 2016 ICD-10-CM valid codes and code titles is posted on the CMS website. The codes are listed in tabular order to reflect the ICD-10-CM code book.
Remember that many major insurers did not offer coding flexibility, so many providers are already using specific codes. Please refer to the appropriate coding guidelines.
Will unspecified codes be allowed once ICD-10 flexibilities expire?
Yes. In ICD-10-CM, unspecified codes have acceptable, even necessary, uses. Information about unspecified codes, including an MLN Matters article and videos, can be found on the CMS website.
While you should report specific diagnosis codes when they are supported by the available medical record documentation and clinical knowledge of the patient’s health condition, in some instances signs/symptoms or unspecified codes are the best choice to accurately reflect the health care encounter.
You should code each health care encounter to the level of certainty known for that encounter.
When sufficient clinical information is not known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate unspecified code
(FOR EXAMPLE, A DIAGNOSIS OF PNEUMONIA HAS BEEN DETERMINED BUT THE SPECIFIC TYPE HAS NOT BEEN DETERMINED).
AsthmaVS
Allergy
ADHDVS
Bipolar Mood
Disorder.
HIVVS
Asymptomatic HIVVS
Screening For HIV
MassVS
Pathology Proven
Malignant Neoplasm
Hypertension
VSElevated BP Leukemia
VSLymphoma
DementiaVS
Depression
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With Our Sophisticated EMR Systems, A Diagnosis Will Fasten Itself And Travel Along With A Patient For Their Lifetime In His Or Her Electronic Chart.
Inaccurately Assigning An Invalid Diagnosis Could Result In Patient Denials For Medications As Well As
Procedures And Services In The Future.
Know That Any Erroneous Diagnosis Reported Is Almost Impossible To Be Expunged From The Patient’s
Record.
This Is Very Significant In Pre-certification, Consultations, Ordering Of Labs
Tests, Procedures And All Other Areas Of Care And Treatment
Research Data:Associated SNOMED codes will provide precise statistical data needed to pinpoint disease classification, sub-classification and associated manifestations within the disease process
What is SNOMED CT?
Is the most comprehensive, multilingual clinical healthcare terminology in the world.
Is a resource with comprehensive, scientifically validated clinical content.
Enables consistent, processable representation of clinical content in electronic health records.
Is mapped to other international standards.
Is already used in more than fifty countries.
Professional reimbursement will change from theCPT code set model to a diagnosis outcome based model.
SNOMED codes are recognized throughout the US and internationally, and it is available at no cost through the National Library of Medicine.
http://www.nlm.nih.gov/research/umls/Snomed/snomed_main.html Using SNOMED-CT
enables providers and electronic medical records to communicate in a common language, thus increasing the quality of patient care across many different provider specialties.
Sounds simple. Unfortunately, it is far from simple.
It is structured into “hierarchies” – 19 of them -- which further define the clinical concept. ( similar to DRG group system)
These hierarchies are then broken down into increasing granularity, resulting in very specific clinical concepts to define a patient’s condition.
For 1 ICD-10 code there may be 36 SNOMED codes
ICD-9
ICD-10 SNOMED
ICD-10 SNOMED
ICD-9 ICD-10 SNOMED
SNOMEDICD-10ICD-9
Multiple Myeloma/ SNOMED
Sub typeCell type
FABGenetic
abnormality
Sub typeCell type
ICD-9ICD-10 SNOMED
Testicular choriocarcinoma is one of the histologic types of nonseminomatous germ cell tumors (NSGCTs), which along with testicular seminoma constitute the two major histologic groups of testicular cancers. Pure choriocarcinoma of the testis is the exception to most of the rules established for testicular seminoma and all other forms of NSGCTs.
Right Clear Cell Carcinoma Kidney
RT
18
19
Documentation
ICD-10 cm
NEW COMBINATION CODES
with acute chest syndrome
with splenic sequestration
Hemoglobin SS Disease
Hemoglobin SS disease is the most common type of sickle cell disease. It occurs when you inherit copies of the hemoglobin S GENE FROM BOTH PARENTS. This forms hemoglobin known as Hb SS.
Hemoglobin SC Disease
Hemoglobin SC disease is the second most common type of sickle cell disease. It occurs when you INHERIT THE HB C GENE FROM ONE PARENT AND THE HB S GENE FROM THE OTHER. Individuals with Hb SC have similar symptoms to individuals with Hb SS. However, the anemia is less severe
Hemoglobin SB+ (Beta) Thalassemia
Hemoglobin SB+ (Beta) thalassemia affects beta globin gene production.
The size of the red blood cell is reduced because less beta protein is made.
If inherited with the Hb S gene, you will have Hemoglobin S Beta thalassemia
Beta-Zero Thalassemia
Beta-Zero thalassemia is the second type of beta thalassemia. It has similar symptoms to HbSS anemia. However, sometimes the symptoms of beta-zero thalassemia are more severe. It is associated with a poorer prognosis
Sickle Cell trait: People who only inherit a mutated gene from only one parent are said to have sickle cell trait. They may have no symptoms or reduced symptoms
D57SickleCell disorders
W/OCrisis
W/Crisis
UnspecifiedAcute Chest Syndrome
With Splenic Sequestration
Hb-SS D57.1 D57.00 D57.01 D57.02
Hb-CHb-SCHb-S/Hb-C
D57.20 D57.219 D57.211 D57.212
Beta ThalassemiaThalassemia Hb-S
D57.40 D57.419 D57.411 D57.412
OtherHb-SD
Hb-SE D57.80 D57.819 D57.811 D57.812
D57.3 Hb-S Trait /Heterozygous hemoglobin S
21
CASE: Sickle Cell
A 15 YO male with sickle cell Hb-SD disease presents to office on emergent basis. He is experiencing symptoms of cough, chest pain fever and shortness of breath. O2 @90% He is diagnosed withSS Hb-SD crisis with acute chest
syndrome and is sent to Ed for straight admission to hospital.
D57.811 Other SS disease crisis with acute chest syndrome
22
25% (1 in 4) chance of having a child with hemoglobin D trait* (A/D)
25% (1 in 4) chance of having a child with sickle cell trait* (A/S)
25% (1 in 4) chance of having a child with hemoglobin SD disease (S/D)
Malignant neoplasms of lymphoid, hematopoietic and related tissue (C81-C96)
ICD-10 Alphabetic Index entries for specific terms:
Leukemia
Lymphoma
Multiple Myeloma
23
Type- Subtype AML with WHO
– FAB (French-American-British) Classification
Acute -Chronic
Not having achieved, failed remission
In remission
Relapse25
AMLAcute myeloid leukemia (AML), also known asacute myelogenous leukemiaor acute nonlymphocytic leukemia(ANLL), AML is a cancer of the myeloid line myeloid blasts of blood cells, characterized by the rapid growth of abnormal white blood cells that accumulate in the bone marrow and interfere with the production of normal blood cells.
ALLAcute lymphoblastic leukemia, also known asacute lymphocytic leukemiaoracute lymphoid leukemia(ALL), is an acute form of leukemia, or cancer of the white blood cellscharacterized by the overproduction and accumulation of cancerous, immature white blood cells, known as lymphoblasts
VIDEO HERE VIDEO HERE
In the 1970s, a group of French, American, and British leukemia experts divided AML into subtypes
M0 through M7
Based on the type of cell from which the leukemia develops
How mature the cells are.
This was based largely on how the leukemia cells looked under the microscope after routine staining.AML with recurrent genetic abnormalities
FAB subtype Name
M0 through M5 all start in immature forms of white blood cells
M0 Undifferentiated acute myeloblastic leukemia
M1 Acute myeloblastic leukemia with minimal maturation
M2 Acute myeloblastic leukemia with maturation
M3 Acute promyelocytic leukemia (APL)
M4 Acute myelomonocytic leukemia
M4 eos Acute myelomonocytic leukemia with eosinophilia
M5 Acute monocytic leukemia
M6 Acute erythroid leukemiatarts in very immature forms of red blood cells
M7 Acute megakaryoblastic leukemia starts in immature forms of cells that make platelets
ICD-9 ICD-10 SNOMED
31
LEUKEMIA
TYPE
AMLNot Having Achieved
Remission/ Failed
REMISSION REPLASE
C92 MYELOID ICD-10 ICD-10 ICD-10
Acute myeloid leukemia
1/ETO
*M0, M1,M2, t(8;21)
C92.00 C92.01 C92.02
AML M3
Acute promyelocytic leukemia, not having
achieved remission C92.40 C92.41 C92.42
AML * M4
AML 4 M4 Eo w/ inv (16) or t(16;16) C92.50 C92.51 C92.52
Acute myeloid leukemia with * 11q23-
abnormality not having achieved remissionC92.60 C92.61 C92.62
Myeloid leukemia, unspecified, not having
achieved remissionC92.90
C92.91 C92.92
Acute myeloid leukemia with multilineage
dysplasia, not having achieved remissionC92.A0 C92.A1 C92.A2
OTHER MYELOID NEC C92.Z0 C92.Z1 C92.Z2
Myeloid unspecified C92.90 C92.91 C92.92
* WHO and FAB Classifications
Leukemia Chart
ACUTE VS CHRONIC VIDEO HERE
Acute
Chronic
Myeloid Lymphoid
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C91 Lymphoid ICD-10 ICD-10 ICD-10
Acute lymphoid
leukemia
Lymphoblastic
C91.00 C91.02 C91.03
Chronic lymphoid
leukemia B CELL
TYPE
C91.10 C91.11 C91.12
Prolymphocytic B cell
typeC91.30 C91.31 C91.32
Hairy Cell C91.40 C91.41 C91.42
Adult T cell
lymphoma leukemia
(HTLV-1-associated)
C91.50 C91.51 C91.52
Prolymphocytic T Cell
TypeC91.60 C91.61 C91.62
Mature B cell Burkitt
TypeC91.A0 C91.A1 C91.A2
Other Lymphoid
LeukemiaC91.Z0 C91.Z1 C91.Z2
Z85.6 Personal History Of Leukemia * New Codes In Icd-10 No Longer Coded As “Other”
LEUKEMIA
TYPE Not having achieved remission/
failed
Remission Relapse
CASE 2
65 Year Old Admitted with severe anemia hgb @6 due to ALL Transfused. Thrombocytopenia PTP plt @9 due to transfusion . Philadelphia- Chromosome negative Acute Lymphoblastic Leukemia s/p CVAD 1-4 a {cyclophosphamide, vincristine, adriamycin, and dexamethasone} remission.
Remission ALL Philadelphia- chromosome negative s/p CVAD 1-4
a {cyclophosphamide, vincristine, adriamycin, and dexamethasone}.
Has leukopenia but no fever. ( due to high dose chemotherapy?)
Hypercalcemia likely 2/2 dehydration. Will start NS IVF @ 150cc/HR
and give Lasix 20 mg iv x 1
C91.01 ALL
D63.0 Anemia in neoplastic disease
D69.51 Post transfusion purpura
E86.0 Dehydration
E83.52 Hypercalcemia
D72.819 Leukopenia Decreased white blood cell count, unspecified
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IN NEOPLASTIC DISEASECode neoplasm first
VIDEO HERE
CHEMOTHERAPY CASE: Patient comes to clinic today for pamidronate infusion for Multiple Myeloma. Met with Dr. prior to clinic appt. Orders obtained.
IV Access: Implanted port at left chest accessed using strict aseptic technique per RN. Site needle prepped with Chlorhexadine scrub X 30-45 seconds, allowed to dry. Accessed using 22G ¾” non-coring needle. Good blood return verified. Flushed with NS 10 ml. Biopatch/transparent drug.
VITALS:
Time B/P Pulse Temp RespPain
0920 150/70 87 99.0 200/10
1325 138/70 55 98.1 180/10
MEDICATION:
Time Medication Dosage RTE IV Sol’Infusion time
11:50 Pamidronate 90mg IV 250ml NSS 90 min
Prescriptions for Warfarin and Dexamethasone picked up at pharmacy window for patient. Lenolidomide order in system.
EDUCATION: Reviewed side effects with patient. He reports he remembers receiving medication in the past. Patient doesn’t remember experiencing any side effects.
DISCHARGE: Infusion completed at 13:25. Port needle removed intact after flush with 20ml NSS followed by 500 units of Heparin per RN. Patient has follow-up appt. scheduled.
Z51.11 Encounter For Antineoplastic Chemotherapy
C90.00 Multiple Myeloma
39
40
Location
Location
Location
Location
VIDEO HERE
Type- Sub Type
Non-Follicular/ Hodgkin
Nodular Lymphocyte
Nodular sclerosis classical
Mixed cellularity classical
Lymphocyte- classical
Lymphocyte- depleted classical
Lymphocyte-rich classical
Other classical
Non-Hodgkin
Small cell B-cell
Mantle Cell
Diffuse large B – cell
Lymphoblastic
Burkitt
Other non follicular
Mycosis fungoides
Sezary disease
Peripheral T-Cell
Anaplastic large cell, ALK positive
Anaplastic large cell, ALK negative
Cutaneous T cell
Other mature T/NK –cell
Mediastinal large B cell
Other specified types of non-Hodgkin
Other specified types of T/NK -cell
Follicular
GRADE I
GRADE II
GRADE III UNSPECIFIED
GRADE III A
GRADE III B
Grade 1: 0-5 centroblasts/high-power field (HPF)
Grade 2: 6-15 centroblasts/HPF
Grade 3: > 15 centroblasts/HPF
1-2 (low-grade). FL grade 3 is divided into 3A and 3B (absence of centrocytes).
The A and B designations denote the absence or presence of symptoms, the presence of symptoms correlates with treatment response. The importance of imaging modalities, such as computed tomography (CT) scanning,
Diffuse
Cutaneous
Other
42
VIDEO HERE
65 year old male with mantle cell lymphoma of the inguinal nodes presents to clinic. He has completed 21 day cycle ofCHOP chemotherapy. Polyneuropathy due to chemo in B/L feet continue vitamin B therapy. nausea without vomiting add Zofran.
C: Cytoxan® (cyclophosphamide) H: Adriamycin® (hydroxy doxorubicin) O: vincristine (Oncovin®) P: Prednisone
Order bone marrow biopsy prior to the allogeneic peripheral stem cell transplant from his match-related brother1. C83.15 Mantel-cell lymphoma, lymph nodes of inguinal
region and lower limb.2. G62.0: Polyneuropathy due to drug3. T45.1x5A adverse effect chemo therapy4. R11.11: Nausea without vomiting
44
45
TypeHead
NeckFace
Intra-
thoracic
Intra Abdominal
Axilla &
Upper Limb
Inguinal
Region & Lower Limb
Intra
Pelvic
Spleen Multiple
SitesExtranodal &
Solid Organs
Unspecifie
d Site
Hodgkin LymphomaNODULAR LYMPHOCYTE PREDOMINANT
C81.01 C81.02 C81.03 C81.04 C81.05 C81.06 C81.07 C81.08 C81.09 C81.00
nodular sclerosisclassical
C81.11 C81.12 C81.13 C81.14 C81.15 C81.16 C81.17 C81.18 C81.19 C81.10
mixed cellularity classical
C81.21 C81.22 C81.23 C81.24 C81.25 C81.26 C81.27 C57.28 C81.29 C81.20
lymphocyte-depletedclassical
C81.31 C81.32 C81.33 C81.34 C81.35 C81.36 C81.37 C81.38 C81.89 C81.30
Lymphocyte-rich classical
C81.41 C81.42 C81.43 C81.44 C81.45 C81.46 C81.47 C81.48 C81.49 C81.40
other classical
C81.71 C81.72 C81.73 C81.74 C81.75 C81.76 C81.77 C81.78 C81.79 C81.70
Unspecified C81.91 C81.82 C81.83 C81.84 C81.85 C91.86 C81.87 C81.88 C81.89 C81.80
Z85.71 Personal history of Hodgkin lymphoma
Lymphoma Charts
46
TypeHead
NeckFace
Intra-
thoracic
Intra Abdominal
Axilla &
Upper Limb
Inguinal
Region & Lower Limb
Intra
Pelvic
Spleen Multipl
e Sites
Extranodal &
Solid Organs
Unspecifie
d Site
C 82 Follicular Lymphoma
GRADE I C82.01 C82.02 C82.03 C82.04 C82.05 C82.06 C82.07 C82.08 C82.09 C82.00
GRADE II C82.11 C82.12 C82.13 C82.14 C82.15 C82.16 C82.17 C82.18 C82.19 C82.10
GRADE III C82.21 C82.22 C82.23 C82.24 C82.25 C82.26 C82.27 C82.28 C82.29 C82.20
GRADE IIIa C82.31 C82.32 C82.33 C82.34 C82.35 C82.36 C82.37 C82.38 C82.39 C82.30
GRADE III b C82.41 C82.42 C82.43 C82.44 C82.45 C82.46 C82.47 C82.48 C82.49 C42.40
C83 Diffuse non- Hodgkin’s lymphoma
Small cellLymphophasmacyticNodal marginal zone
C83.01 C83.02 C83.03 C83.04 C83.05 C83.06 C83.07 C83.08 C83.09 C83.00
Mantle cell C83.11 C83.12 C83.13 C83.14 C83.15 C83.16 C83.17 C83.18 C83.19 C83.10
Diffuse Large cell-B C83.31 C83.32 C83.33 C83.34 C83.35 C83.36 C83.37 C83.38 C83.39 C83.30
Lymphoblastic-diffuse
C83.51 C83.52 C83.53 C83.54 C83.55 C83.56 C83.57 C83.58 C83.59 C83.50
Burkitt Lymphoma C83.71 C83.72 C83.73 C83.74 C83.75 C83.76 C83.77 C83.78 C83.79 C83.70
Other types Intravascular Lg B CellLymphoid GranulomatosisPrimary effusion B cell
C83.81 C83.82 C83.83 C83.84 C83.85 C83.86 C83.87 C83.88 C83.89 C83.80
Non-follicular, Unspec
C93.91 C93.92 C83.93 C83.94 C83.95 C83.96 C83.96 C83.97 C83.99 C83.90
Lymphoma Charts
47
TypeHead
NeckFace
Intra-
thoracic
Intra Abdominal
Axilla &
Upper Limb
Inguinal
Region & Lower Limb
Intra
Pelvic
Spleen Multiple
SitesExtranodal &
Solid Organs
Unspecifie
d Site
C84 Mature T/NK – cell
Mycosis fungoides C84.01 C84.02 C84.03 C84.04 C84.05 C84.06 C84.07 C84.08 C84.09 C84.00
Sezary disease C84.11 C84.12 C84.13 C84.14 C84.15 C84.16 C84.17 C84.18 C84.19 C84.10
Peripheral T cell
Lennerts's Lymphoepithelioid
C84.41 C84.42 C84.43 C84.44 C84.45 C84.46 C84.47 C84.48 C84.49 C84.40
Anaplastic large cell,
ALK+ CD30-+
C84.61 C84.62 C84.63 C84.64 C84.65 C84.66 C84.67 C84.68 C84.69 C84.60
Anaplastic ALK - C84.71 C84.72 C84.73 C84.74 C84.75 C84.76 C84.77 C84.78 C84.79 C84.70
Cutaneous T cell, unspec C84A1 C84.A2 C84.A3 C84.A4 C84.A5 C84.A6 C84.A7 C84.A8 C84.A9 C84.A0
Other T/NK-cell C84Z1 C84.Z2 C84.Z3 C84.Z4 C84.Z5 C84.Z6 C84.Z7 C84.Z8 Z84.Z9 C84.Z0
Mature T/NK, NOS C94.91 C94.92 C94.93 C94.94 C94.95 C94.96 C94.97 C94.98 C94.99 C94.90
C85 Other Specified And Unspecified Types Of Non-Hodgkin Lymphoma
B cell unspecified C85.11 C85.12 C85.13 C85.14 C85.15 C85.16 C85.17 C85.18 C85.19 C85.10
Mediastinal( thymic) large B cell
C85.21 C85.22 C85.23 C85.24 C85.25 C85.26 C85.27 C85.28 C85.29 C85.20
Other specified Non- Hodgkin
C85.81 C85.82 C85.83 C85.84 C85.85 C85.86 C85.87 C85.88 C85.89 C85.80
Non-Hodgkin unspecified
C85.91 C85.92 C85.93 C85.94 C85.95 C85.96 C85.97 C85.98 C85.99 C85.90
C88.0 Waldenstrom macroglobulinemia
C88.3 Immunoproliferative small intestine Alpha heavy chain – Mediterranean lymphoma
C88.8 Other malignant immunoproliferative disease
C88.2 Heavy chain disease C88.4 Extranodal marginal zone B-cell lymphoma
C88.9 Immunoproliferative disease NOS
Lymphoma Charts
Leukemia, Multiple Myeloma, and Malignant Plasma Cell Neoplasms
“in remission versus personal history”
The categories for leukemia, and category C90, Multiple myeloma and malignant plasma cell neoplasms, have codes indicating whether or not the leukemia has achieved remission.
Need to distinguish remission vs. personal history
Z85.6 Personal history of leukemia
Excludes 1: leukemia in remission C91.0-C95.9 with 5th character 1
Z85.79 Personal history of other malignant neoplasms of lymphoid, hematopoietic and related tissues.
Excludes 1: multiple myeloma in remission (C90.01)
If the documentation is unclear, as to whether the leukemia/myeloma has achieved remission, the provider should be queried.
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Bone Marrow Power Biopsy NeedleCMS guidelines NCCI chapter 5 section E
Bone Marrow aspiration performed alone report code 38221
Bone Marrow biopsy is performed alone report code 38220
When aspiration and biopsy are performed through the same
incision and same bone site code only the biopsy 38220
Medicare: For sequenced biopsy and aspiration through the same incision
38221 Biopsy G0364 aspiration performed with biopsy through same incision on the same day
The Codes 33220 and 33221 may only be reported together if the two procedures are performed different bones or two different incisions on the same bone or at separate patient encounters
VIDEO HERE
Coding Guidance with
Bone Marrow
Biopsy and Aspiration
77002: Fluoroscopic guidance needle placement
76942; Ultrasound guidance for needle placement
77012: CT guidance for needle placement
Aspiration, biopsy, injection localization device
ASC, Outpatient, Inpatient Hospital append
-26 professional component
VIDEO HERE
Patient NameMRN#DOB:
Hematology Office123 Best Practice Anywhere StreetYourtown, NJ
US guidance used: yes no
CR8863 provides that CMS is establishing the following four new HCPCS modifiers (referred to collectively as -X{EPSU} modifiers) to define specific subsets of the -59 modifier:
XE Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate Encounter, XS Separate Structure, A Service That Is Distinct Because It Was Performed On A Separate Organ/Structure, XP Separate Practitioner, A Service That Is Distinct Because It Was Performed By A Different Practitioner, and XU Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service.
CMS will continue to recognize the -59 modifier, but notes that Current Procedural Terminology (CPT) instructions state that the-59 modifier should not be used when a more descriptive modifier is available. While CMS will continue to recognize the -59 modifier in many instances, it may selectively require a more specific - X{EPSU} modifier for billing certain codes at high risk for incorrect billing. For example, a particular NCCI PTP code pair may be identified as payable only with the -XE separate encounter modifier but not the -59 or other -X{EPSU} modifiers. The -X{EPSU} modifiers are more selective versions of the -59 modifier so it would be incorrect to include both modifiers on the same line.
When stem cells are collected from bone marrow and transplanted into a patient, the procedure is known as a bone marrow transplant.
If the transplanted stem cells came from the bloodstream, the procedure is called a peripheral blood stem cell transplant—sometimes shortened to “stem cell transplant.”
VIDEO HERE VIDEO HERE
Allogeneic “Allo”/ Syngeneic Autologous “Auto”
Code first underlying cause, such as: Complications of transplanted organs and tissue (T86.-)
Complications of blood transfusion (T80.89)
Use additional code to identify associated manifestations, such as: Desquamative dermatitis (L30.8)
Diarrhea (R19.7)
Elevated bilirubin (R17)
Hair loss (L65.9)
Identify if: Acute D89.810
Chronic D89.811
Acute On Chronic D89.812
Unspecified D89.813
55
Coding
Manifestations of cGVHD
AML in remission status post Allo BMSCT - HPC brother 26 months ago. She has chronic GVHD skin with evidenced of desquamative erythema by red shedding plaques and rippling of bilateral lower extremities. Skin cGVHD is improving on Gleevec 100 mg daily. Her onset of gritty and painful bilateral dry eye syndrome cGVHD is minimally improving prescribed autologous serum tears. New onset of diarrhea will check for c diff.
56
Icd-10 DESCRIPTIONComplication stem cell transplant
T86.5
Complication of bone marrow transplant
T86.00 Unspecified
T86.06 rejection
T86.02 transplant failure
T86.03 infection
T86.09 other complications of BM transplant
C92.01 Acute Myeloid Leukemia,
unspec subtype,
in remission
T86.5 Complications of stem cell transplant
D89.811 Chronic Graft VS Host Disease
L54 Erythematous Conditions In Diseases
Classified Elsewhere ( new code)
H04.123 Dry Eye Syndrome Bilateral, Left, Right
R17.9 Diarrhea
96450
I was present for the key and critical components of the
procedureDr. Attending
MedicareGC
38204 Management of recipient hematopoietic progenitor cell donorsearch and cell acquisitionThis code is for physician supervision of the donor search for allogeneic transplants. This can include supervision of the coordinator who is conducting the search for an unrelated donor, as well as communication with the donor center medical director and the harvesting physician on theappropriate cell dose collection.
This is a one-time charge.
If a second transplant needs to be done, a second charge can be billed under this code. (As explained later, there is a new code for donor lymphocyte infusion, so it is not necessary to re-use thiscode again for DLI as a supplement to the original graft.) Previously there hasn’t been a CPT Code for finding an unrelated donor and collecting stem cells.
The code can encompasses a wide range of services for donor search and acquisition including submission of data to registries, evaluation of registry reports, requests for further typing of multiple candidates, communication with the donor center on type and number of cells to be collected and thebest cryopreservation method, assessment of any T-cell contamination or ABO mismatching that might place the recipient at greater risk for graft versus-host disease, and surveillance for bacterial or fungal contamination that could compromise the transplant and injure the patient.
Code 38204 is not to be used for billing for the routine services for orders from NMDP, such as DR typing, confirmatory typing or infectious disease sampling. These services should be billed with either a generic CPT code or no code at all. Efforts are underway to establish HCPCS Level II Service codes for these services so that they may be submitted electronically with minimal risk of redlining by third-party payers.
38205 Blood-derived hematopoietic progenitor cell harvesting for
transplantation, per collection; ALLOGENEIC
38206 Blood-derived hematopoietic progenitor cell harvesting fortransplantation, per collection; AUTOLOGOUS
The codes are for supervision of the donor on the apheresis machine.
These two codes should not be used for H&P assessment or post-apheresisassessment, which should be billed under standard E&M codes.
Note that this is a per diem charge, so if there are multiple collections on multiple days, this service code may be billed on multiple days.The physician needs to document a patient examination during the time of the apheresis document supervision of the technician managing the equipment and the patient. If the physician actually performs the apheresis procedure, a modifier should be attached.
38207 Transplant preparation of hematopoietic progenitor cells; cryopreservation and storage
38208 Thawing of previously frozen harvest
38209 Washing of harvest
For the facility fees, factors include the technician time, supply time, machineusage and machine depreciation. In all of these codes there can be 10-yearamortization of the construction costs as indirect expenses of the GMP lab.
For physician supervision there clearly needs to be a physician note. Flow cytometry done for quality assessment is part of these CPT codes andcannot be billed independently.The cost of flow cytometry must be billed within the context of these CPT codes.
38240Bone marrow or blood-derived peripheral stem cell transplantation; allogeneic. Hematopoietic progenitor cells( known as blood forming HPC) This is the cell in the bone marrow that is known as the “parent” cell from which other blood cells, red, white, platelets are developedConsists of High dose chemotherapy and than progenitor cell infusion38241Bone marrow or blood-derived peripheral stem celltransplantation; autologous
The codes are for describing the care and supervision of the patient while the stem cells are being infused. Previously many coders have tried to include cell collection and processing within these codes.
CPT code 38243 is reported when an HPC boost is given due to complications from administration of marrow suppressive medications to treat infection post-transplant.A typical scenario is a patient who is pancytopenic post transplant
with a cytomegalovirus (CMV) infection and is being treated with ganciclovir. The goal of the boost is to provide the patient with an infusion of additional“original” donor stem cells to restore normal blood counts and to minimize the risks associated with cytopenias.38243 A subsequent allogeneic infusion, utilizing an “original” donor’s cells, is less likely to result in an acute reaction or graft-versus-host disease asa consequence of the subsequent infusion compared to theoriginal infusion; however, the risk does remain.
* Codes 38240,38242,38243 should not be reported on the same day
Post transplant infusion management of adverse effects are reported separately Reported using the appropriate E/M code based
on POS
If a separately E/M is performed on the same day as infusion it may be reported with modifier -25
Immunosuppressant management is separately billable after transplant
38242 Allogeneic donor lymphocyte infusionsIn this procedure the provider introduces into a recipient the lymphocytes which were harvested and separated from another's donor’s bloodThis infusion can be done at any time AFTER an initial transplant
Another therapy which uses the immune system to try to fight the tumor is donor lymphocyte infusions or DLI. Patients relapsing after an allogeneic marrow transplant have few treatment options. Several groups have found that transfusion of donor white cells into patients, especially those with relapsed chronic myelogenous leukemia, is successful in re-inducing a remission in these patients.Many of these patients have Graft-versus-Host disease induced by this type of treatment. The toxicity seen with donor lymphocyte infusion can be significant if either severe Graft-versus-Host disease or marrow toxicity from the lymphocyte infusions occurs. However, this toxicity is milder than seen with attempts at a second marrow transplants. Currently we are exploring the use of donor lymphocyte infusion in patients who have relapsed after transplant.The dose of lymphocytes given and the schedule is dependent on the disease which has relapsed.
Patients with rapidly progressing tumors may first need to be treated with chemotherapy. Depending on the disease, multiple infusions of white cells may be tried until a remission or significant side effects are obtained. Some patients receiving this type of treatment require a second marrow transfusion (without a preparative regimen) because of low count. Patients at high risk for relapse may also be offered DLI while they are still in remission after BMT.* John Hopkins Immunologic Manipulations to Treat Blood and Bone Marrow Cancers
APHERESIS Cell Processing
36511 Therapeutic apheresis; for white blood cells38207
Transplant preparation of hematopoietic progenitor cells; cryopreservation and storage
36512 Therapeutic apheresis; for red blood cells38208
Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, without washing, per donor
36513 Therapeutic apheresis; for platelets38209
Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, with washing, per donor
36514 Therapeutic apheresis; for plasma pheresis38210
preparation of hematopoietic progenitor cells; specific cell depletion within harvest, T-cell depletion
36515 Therapeutic apheresis; with extracorporeal immunoadsorption and plasma reinfusion
38211preparation of hematopoietic progenitor cells; tumor cell depletion
36516 Therapeutic apheresis; with extracorporeal selective adsorption or selective filtration and plasma reinfusion
38212preparation of hematopoietic progenitor cells; red blood cell removal
Donor Search 38213 preparation of hematopoietic progenitor cells; platelet depletion
38204 Management of recipient hematopoietic progenitor cell donor search and cell acquisition
38214preparation of hematopoietic progenitor cells; plasma (volume) depletion
Stem Cell Collection 38215 preparation of hematopoietic progenitor cells; cell concentration in plasma, mononuclear, or buffy coat layer
38205 Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; allogeneic
38206 Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; autologous
Transplantation HPC
Bone Marrow Biopsy and Aspiration/Harvest38240 Hematopoietic progenitor cell (HPC); allogeneic transplantation per
donor
38220 Bone marrow; aspiration only 38241 Hematopoietic progenitor cell (HPC); autologous transplantation
38221 Bone marrow; biopsy, needle or trocar 38243 Hematopoietic progenitor cell (HPC); HPC boost
G0364 aspiration performed with biopsy through same incision on the same day Medicare only
38242 Allogeneic lymphocyte infusions
38230 Bone marrow harvesting for transplantation; allogeneic Guidance for Biopsy/Aspiration
*26 Inpatient, outpatient, ASC
38232 Bone marrow harvesting for transplantation; autologous 77022 Fluoroscopic guidance needle placement
0232T Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed
76942 US guidance for needle placement
77012 CT guidance for needle placement
Allogeneic vs. Autologous• Medicare billing instructions clarify the following:“Acquisition charges for stem cell transplants apply only toallogeneic transplants, for which stem cells are obtained from adonor. Acquisition charges do not apply to autologous transplants,because autologous transplants involve services provided to thebeneficiary only for which the hospital may bill and receive payment.”(CMS Publication 100-04, Ch. 3, Section 90.3.3.A)“The hospital bills and shows all charges for autologous stem cellharvesting, processing, and transplant procedures based on thestatus of the patient when the services are furnished.”(CMS Publication 100-04, Ch. 3, Section 90.3.3.B)
“Acquisition charges for allogeneic stem cell transplants include, but are not limited to, charges for the costs of the following services:
– National Marrow Donor Program fees, if applicable, for stem cells from anunrelated donor– Tissue typing of donor and recipient
– Donor evaluation
– Physician pre-procedure donor evaluation services
– Costs associated with harvesting procedure• (e.g., general routine and special care services, procedure/operating room and otherancillary services, apheresis services, etc.)
– Post-operative/post-procedure evaluation of donor– Preparation and processing of stem cells”
CMS Publication 100-04, Chapter 3 Section 90.3.3.A
AAPC 2015 procedure desk reference
AAPC ICD-10 code set draft 2014
AMA CPT 2017
(CMS Publication 100-04, Ch. 3, Section 90.3.3.A)
Super Coder 40408 2012
https://www.nlm.nih.gov/healthit/snomedct/us_edition.html
D57SickleCelldisorders
W/OCrisis
W/CrisisUnspec.
w/ Acute Chest Syndrome
w/Splenic Sequestration
search terms
Hb-SS D57.1 D57.00 D57.01 D57.02
hbss Hb-ss262.61// 262.62
Hb-CHb-SCHb-S/Hb-C
D57.20 D57.219 D57.211 D57.212Sickle cell hbcHbchbc
BetaThalassemiaThalassemia
Hb-S
D57.40 D57.419 D57.411 D57.412Sickle cell thalassemia
OtherHb-S Hb-DHb-S/ Hb-E
D57.80 D57.819 D57.811 D57.812Sickle cell other
Other hemoglobinopathiesHb C Hb D Hb E
D58.2 Other hemoglobinopathies
D57.3 Hb-S Trait /Heterozygous hemoglobin S Sickle cell trait
70
71
LEUKEMIA
TYPE Not having achieved remission/ failed Remission Relapse
C92 MYELOID ICD-10 ICD-10 ICD-10
Acute myeloid leukemia
1/ETO
*M0, M1,M2, t(8;21)
C92.00 C92.01 C92.02
AML M3
Acute promyelocytic
leukemia, not having
achieved remission
* Inclu
de
WH
O &
FA
B C
lassifica
tion
C92.40 C92.41 C92.42
AML * M4
AML 4 M4 Eo w/ inv (16) or
t(16;16)C92.50 C92.51 C92.52
Acute myeloid leukemia
with * 11q23-abnormality
not having achieved
remission
C92.60 C92.61 C92.62
Myeloid leukemia,
unspecified, not having
achieved remissionC92.90 C92.91 C92.92
Acute myeloid leukemia
with multilineage
dysplasia, not having
achieved remission
C92.A0 C92.A1 C92.A2
OTHER MYELOID NEC C92.Z0 C92.Z1 C92.Z2
Myeloid unspecified C92.90 C92.91 C92.92
Leukemia Chart
72
LEUKEMIA
TYPE
AMLNot Having Achieved
Remission/ Failed
REMISSION REPLASE
C92 MYELOID ICD-10 ICD-10 ICD-10
Acute myeloid leukemia
1/ETO
*M0, M1,M2, t(8;21)
C92.00 C92.01 C92.02
AML M3
Acute promyelocytic leukemia, not having
achieved remission C92.40 C92.41 C92.42
AML * M4
AML 4 M4 Eo w/ inv (16) or t(16;16) C92.50 C92.51 C92.52
Acute myeloid leukemia with * 11q23-
abnormality not having achieved remissionC92.60 C92.61 C92.62
Myeloid leukemia, unspecified, not having
achieved remissionC92.90
C92.91 C92.92
Acute myeloid leukemia with multilineage
dysplasia, not having achieved remissionC92.A0 C92.A1 C92.A2
OTHER MYELOID NEC C92.Z0 C92.Z1 C92.Z2
Myeloid unspecified C92.90 C92.91 C92.92
* WHO and FAB Classifications
Leukemia Chart
73
C91 Lymphoid ICD-10 ICD-10 ICD-10
Acute lymphoid
leukemia
Lymphoblastic
C91.00 C91.02 C91.03
Chronic lymphoid
leukemia B CELL
TYPE
C91.10 C91.11 C91.12
Prolymphocytic B cell
typeC91.30 C91.31 C91.32
Hairy Cell C91.40 C91.41 C91.42
Adult T cell
lymphoma leukemia
(HTLV-1-associated)
C91.50 C91.51 C91.52
Prolymphocytic T Cell
TypeC91.60 C91.61 C91.62
Mature B cell Burkitt
TypeC91.A0 C91.A1 C91.A2
Other Lymphoid
LeukemiaC91.Z0 C91.Z1 C91.Z2
Z85.6 Personal History Of Leukemia * New Codes In Icd-10 No Longer Coded As “Other”
LEUKEMIA
TYPE Not having achieved remission/
failed
Remission Relapse
74
LEUKEMIA
TYPE NOT HAVING ACHIEVED
REMISSION/ FAILED
REMISSION REPLASE
C93 MONOCYTIC ICD-10 ICD-10 ICD-10Acute Monocytic
AML 5 AML M5b
AML M5aC93.00 C93.01 C93.02
Chronic Monocytic
CMML-1
CMML-2
CMML W/ eosinophilia
C93.10 C93.11 C93.12
Juvenile myelomonocytic C93.30 C93.31 C93.32Other NOS C93.Z0 C93.Z1 C93.Z2UNSPECIFIED C93.90 C93.91 C93.92C94 OTHER LEUKEMIAS OF SPECIFIED TYPEICD ICD-9 ICD-10 ICD-9 ICD-10
Acute M6 (a) ( b)
ErythroleukemiaC94.00 C94.01 C94.02
Acute megakaryoblastic C94.20 C94.21 C94.22Mast Cell C94.30 C94.31 C94.32Acute Panmyelosis with
myelofibrosisC94.40
238.79C94.412 C94.42
C94.6 Myelodysplastic disease
Other aggressive NK-cell
Acute basophilicC94.80 C94.81 C94.80
C95 UNSPECIFIED TYPE ICD-10 ICD-10 ICD-10
Acute leukemia unspec. C95.00 C95.01 C95.02Chronic, unspecified type C95.10 C95.11 C95.12Unspecified Leukemia C95.90 C95.91 C95.92
Leukemia Chart
75
Other lymphatic and hematopoietic tissues ICD-9 ICD-10Essent ial thrombocythemia
D47.3 Essent ial (hemorrhagic) thrombocythemia
Low grade myelodysplast ic syndrome
lesions
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.20 Refractory anemia with excess of blasts, unspecified
D46.21 Refractory anemia with excess of blasts 1
D46.4 Refractory anemia, unspecified
D46.A Refractory cytopenia with mult ilineage dysplasia
D46.B Refractory cytopenia with mult ilineage dysplasia and ring sideroblasts
High grade myelodysplast ic syndrome
lesions
D46.22 Refractory anemia with excess of blasts 2
Use addit ional code for adverse effect , if applicable, to ident ify drug (T36-T50
with fifth or sixth character 5) drug-induced aplast ic anemia (D61.1)
Myelodysplast ic syndrome with 5q
delet ion D46.C Myelodysplastic syndrome with 5q delet ion
Myelodysplast ic syndrome, unspecified D46.9 Myelodysplastic syndrome, unspecified
Use addit ional code for adverse effect , if applicable, to ident ify drug (T36-T50
with fifth or sixth character 5) drug-induced aplast ic anemia (D61.1)
D46.Z Other myelodysplast ic syndromes
Use addit ional code for adverse effect , if applicable, to ident ify drug (T36-T50
with fifth or sixth character 5) chronic myelomonocyt ic leukemia (C93.1-)
drug-induced aplast ic anemia (D61.1)
Post -t ransplant lymphoproliferat ive
disorder [PTLD] Code first complicat ions
of t ransplant
D47.Z1 Post -t ransplant lymphoproliferat ive disorder (PTLD)
*Code first complications of t ransplanted organs and t issue (T86.-)
T86 .00 Unspecified complicat ion of bone marrow transplant
T86.01 Bone marrow transplant reject ion
T86.02 Bone marrow transplant failure
T86.03 Bone marrow transplant infect ion
T86.09 Bone marrow transplant other
T86.5 : Complicat ion stem cell t ransplant
279.51
279.52
279.53
279.50
D89.810Acute graft-versus-host disease D89.811 Chronic graft-versus-host disease D89.812 Acute on chronic graft-versus-host disease D89.813 Graft-versus-host disease, unspecified * code first complication of transplant
279.41 D89.82 Autoimmune lymphoproliferative syndrome [ALPS]
76
C91 Lymphoid ICD-10 ICD-10 ICD-10
Acute lymphoid leukemia
LymphoblasticC91.00 C91.02 C91.03
Chronic lymphoid leukemia B
CELL TYPEC91.10 C91.11 C91.12
Prolymphocytic B cell type C91.30 C91.31 C91.32
Hairy Cell C91.40 C91.41 C91.42
Adult T cell lymphoma
leukemia
(HTLV-1-associated)
C91.50 C91.51 C91.52
Prolymphocytic T Cell Type C91.60 C91.61 C91.62
Mature B cell Burkitt Type C91.A0 C91.A1 C91.A2
Other Lymphoid Leukemia C91.Z0 C91.Z1 C91.Z2
Z85.6 Personal History Of Leukemia
LEUKEMIA
TYPENot having achieved
remission/ failedREMISSION REPLASE
77
LEUKEMIATYPE
MONOCYTIC
Not Having Achieved
Remission/ Failed
REMISSION REPLASE
C93 MONOCYTIC ICD-10 ICD-10 ICD-10Acute Monocytic
AML 5 AML M5b
AML M5aC93.00 C93.01 C93.02
Chronic Monocytic
CMML-1
CMML-2
CMML W/ eosinophilia
C93.10 C93.11 C93.12
Juvenile myelomonocytic C93.30 C93.31 C93.32Other NOS C93.Z0 C93.Z1 C93.Z2UNSPECIFIED C93.90 C93.91 C93.92C94 OTHER LEUKEMIAS OF SPECIFIED TYPEICD ICD-9 ICD-10 ICD-9 ICD-10
Acute M6 (a) ( b) ErythroleukemiaC94.00 C94.01 C94.02
Acute megakaryoblastic C94.20 C94.21 C94.22Mast Cell C94.30 C94.31 C94.32Acute Panmyelosis with
myelofibrosisC94.40
238.79C94.412 C94.42
C94.6 Myelodysplastic disease
Other aggressive NK-cell
Acute basophilicC94.80 C94.81 C94.80
C95 UNSPECIFIED TYPE ICD-10 ICD-10 ICD-10
Acute leukemia unspec. C95.00 C95.01 C95.02Chronic, unspecified type C95.10 C95.11 C95.12Unspecified Leukemia C95.90 C95.91 C95.92
Leukemia Chart
78
Other lymphatic and hematopoietic tissues Description ICD-10Essent ial thrombocythemia
D47.3 Essent ial (hemorrhagic) thrombocythemia
Low grade myelodysplast ic syndrome
lesions
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.20 Refractory anemia with excess of blasts, unspecified
D46.21 Refractory anemia with excess of blasts 1
D46.4 Refractory anemia, unspecified
D46.A Refractory cytopenia with mult ilineage dysplasia
D46.B Refractory cytopenia with mult ilineage dysplasia and ring sideroblasts
High grade myelodysplast ic syndrome
lesions
D46.22 Refractory anemia with excess of blasts 2
Use addit ional code for adverse effect , if applicable, to ident ify drug (T36-T50
with fifth or sixth character 5) drug-induced aplast ic anemia (D61.1)
Myelodysplast ic syndrome with 5q
delet ion D46.C Myelodysplastic syndrome with 5q delet ion
Myelodysplast ic syndrome, unspecified D46.9 Myelodysplastic syndrome, unspecified
Use addit ional code for adverse effect , if applicable, to ident ify drug (T36-T50
with fifth or sixth character 5) drug-induced aplast ic anemia (D61.1)
D46.Z Other myelodysplast ic syndromes
Use addit ional code for adverse effect , if applicable, to ident ify drug (T36-T50
with fifth or sixth character 5) chronic myelomonocyt ic leukemia (C93.1-)
drug-induced aplast ic anemia (D61.1)
Post -t ransplant lymphoproliferat ive
disorder [PTLD] Code first complicat ions
of t ransplant
D47.Z1 Post -t ransplant lymphoproliferat ive disorder (PTLD)
*Code first complications of t ransplanted organs and t issue (T86.-)
T86 .00 Unspecified complicat ion of bone marrow transplant
T86.01 Bone marrow transplant reject ion
T86.02 Bone marrow transplant failure
T86.03 Bone marrow transplant infect ion
T86.09 bone marrow transplant other
Graft VS Host Disease D89.810Acute graft-versus-host disease D89.811 Chronic graft-versus-host disease D89.812 Acute on chronic graft-versus-host disease D89.813 Graft-versus-host disease, unspecified * code first complication of transplant
279.41 D89.82 Autoimmune lymphoproliferative syndrome [ALPS]
79
TypeHead
NeckFace
Intra-
thoracic
Intra
Abdominal
Axilla &
Upper Limb
Inguinal
Region & Lower Limb
Intra
Pelvic
Spleen Multipl
e Sites
Extranodal &
Solid Organs
Unspecifie
d Site
Hodgkin Lymphoma NODULAR LYMPHOCYTE PREDOMINANT
C81.01 C81.02 C81.03 C81.04 C81.05 C81.06 C81.07 C81.08 C81.09 C81.00
nodular sclerosisclassical
C81.11 C81.12 C81.13 C81.14 C81.15 C81.16 C81.17 C81.18 C81.19 C81.10
mixed cellularity classical
C81.21 C81.22 C81.23 C81.24 C81.25 C81.26 C81.27 C57.28 C81.29 C81.20
lymphocyte-depletedclassical
C81.31 C81.32 C81.33 C81.34 C81.35 C81.36 C81.37 C81.38 C81.89 C81.30
Lymphocyte-rich classical
C81.41 C81.42 C81.43 C81.44 C81.45 C81.46 C81.47 C81.48 C81.49 C81.40
other classical C81.71 C81.72 C81.73 C81.74 C81.75 C81.76 C81.77 C81.78 C81.79 C81.70
Unspecified C81.91 C81.92 C81.93 C81.94 C81.95 C91.96 C81.97 C81.98 C81.99 C81.90
Z85.71 Personal history of Hodgkin lymphoma
Lymphoma Charts
80
TypeHead
NeckFace
Intra-
thoracic
Intra
Abdominal
Axilla &
Upper Limb
Inguinal
Region & Lower Limb
Intra
Pelvic
Spleen Multiple
Sites
Extranodal
& Solid Organs
Unspecified
Site
C 82 Follicular { nodular}Non-Hodgkin’s Lymphoma
GRADE I C82.01202.01
C82.02 C82.03 C82.04 C82.05 C82.06 C82.07 C82.08 C82.09 C82.00
GRADE II C82.11 C82.12 C82.13 C82.14 C82.15 C82.16 C82.17 C82.18 C82.19 C82.10
GRADE III C82.21 C82.22 C82.23 C82.24 C82.25 C82.26 C82.27 C82.28 C82.29 C82.20
GRADE IIIa C82.31 C82.32 C82.33 C82.34 C82.35 C82.36 C82.37 C82.38 C82.39 C82.30
GRADE III b C82.41 C82.42 C82.43 C82.44 C82.45 C82.46 C82.47 C82.48 C82.49 C42.40
Diffuse folliclecenter
C82.51 C82.52 C82.53 C85.54 C82.55 C82.56 C82.57 C82.58 C82.59 C82.50
Cutaneous follicle center
C82.61 C82.62 C82.63 C82.64 C82.65 C82.66 C82.67 C82.68 C82.69 C82.60
Other types of follicular
C82.81 C82.82 C82.83 C82.84 C82.85 C82.86 C82.87 C82.88 C82.89 C82.00
Follicular ,unspecified
C82.91 C82.92 C82.93 C82.94 C82.95 C82.96 C82.97 C82.98 C82.99 C82.90
Lymphoma Charts
81
TypeHead
NeckFace
Intra-
thoracic
Intra
Abdominal
Axilla
& Upper Limb
Inguinal
Region & Lower Limb
Intra
Pelvic
Spleen Multiple
Sites
Extranodal &
Solid Organs
Unspecified
Site
C83 Diffuse non- Hodgkin’s lymphoma
Small cell bLymphophasmacytic
Nodal marginal zone
C83.01 C83.02 C83.03 C83.04 C83.05 C83.06 C83.07 C83.08 C83.09 C83.00
200.40 Mantle cell C83.11 C83.12 C83.13 C83.14 C83.15 C83.16 C83.17 C83.18 C83.19 C83.10
lymphomaDiffuse Large cell-BDiffuse large T cell rich200.00 reticulosarcoma 200.70 Large cell
C83.31 C83.32 C83.33 C83.34 C83.35 C83.36 C83.37 C83.38 C83.39 C83.30
200.10 Lymphoblastic-diffuse
C83.51 C83.52 C83.53 C83.54 C83.55 C83.56 C83.57 C83.58 C83.59 C83.50
200.20 Burkitt Lymphoma C83.71 C83.72 C83.73 C83.74 C83.75 C83.76 C83.77 C83.78 C83.79 C83.70
Other types Intravascular Lg. B CellLymphoid GranulomatosisPrimary effusion B cell
C83.81 C83.82 C83.83 C83.84 C83.85 C83.86 C83.87 C83.88 C83.89 C83.80
Non-follicular, Unspec C93.91 C93.92 C83.93 C83.94 C83.95 C83.96 C83.96 C83.97 C83.99 C83.90
Lymphoma Charts
82
TypeHead
NeckFace
Intra-
thoracic
Intra
Abdominal
Axilla &
Upper Limb
Inguinal
Region & Lower Limb
Intra
Pelvic
Spleen Multiple
Sites
Extranodal
& Solid Organs
Unspec.
Site
C84 Mature T/NK – cell
Mycosis fungoides C84.01 C84.02 C84.03 C84.04 C84.05 C84.06 C84.07 C84.08 C84.09 C84.00
Sezary disease C84.11 C84.12 C84.13 C84.14 C84.15 C84.16 C84.17 C84.18 C84.19 C84.10
Peripheral T cell
Lennerts's Lymphoepithelioid
C84.41 C84.42 C84.43 C84.44 C84.45 C84.46 C84.47 C84.48 C84.49 C84.40
Anaplastic large cell, ALK+
CD30-+
C84.61 C84.62 C84.63 C84.64 C84.65 C84.66 C84.67 C84.68 C84.69 C84.60
Anaplastic ALK - C84.71 C84.72 C84.73 C84.74 C84.75 C84.76 C84.77 C84.78 C84.79 C84.70
Cutaneous T cell, unspec C84A1 C84.A2 C84.A3 C84.A4 C84.A5 C84.A6 C84.A7 C84.A8 C84.A9 C84.A0
Other T/NK-cell C84.Z1 C84.Z2 C84.Z3 C84.Z4 C84.Z5 C84.Z6 C84.Z7 C84.Z8 Z84.Z9 C84.Z0
Mature T/NK, NOS C84.91 C84.92 C84.93 C84.94 C84.95 C84.96 C84.97 C84.98 C84.99 C84.90
C85 Other Specified And Unspecified Types Of Non-Hodgkin Lymphoma
B cell unspecified C85.11 C85.12 C85.13 C85.14 C85.15 C85.16 C85.17 C85.18 C85.19 C85.10
Mediastinal (thymic)large B-cell lymphoma
C85.21 C85.22 C85.23 C85.24 C85.25 C85.26 C85.27 C85.28 C85.29 C85.20
Other specified
Non- Hodgkin
C85.81 C85.82 C85.83 C85.84 C85.85 C85.86 C85.87 C85.88 C85.89 C85.80
Non-Hodgkin unspecified C85.91 C85.92 C85.93 C85.94 C85.95 C85.96 C85.97 C85.98 C85.99 C85.90
C88.0 Waldenstrom
macroglobulinemia
C88.3 Immunoproliferative small intestine
Alpha heavy chain – Mediterranean lymphoma
C88.8 Other malignant immunoproliferative disease
C88.2 Heavy chain disease C88.4 Extranodal marginal zone B-cell lymphoma C88.9 Immunoproliferative disease NOS
ChronicMyeloid BCR/ABL+
C92.10 C92.11 C92.12
ChronicMyeloid BCR/ABL-
C92.20 C92.22 C92.22
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