Reporting Hodgkin’s Lymphoma Using ICD-10 Codes

Hello everyone and welcome to our podcast series!

My name is Natalie Tornese and I’m a Senior Solutions Manager at Outsource Strategies International (OSI). I wanted to take this opportunity to talk to you about Hodgkin’s Lymphoma.

Hodgkin’s lymphoma is a type of cancer that develops in the lymphatic system. The lymphatic system is a network of nodes connected by vessels that drain fluids and other waste products from the body and fight infections. The lymph nodes act as tiny filters, straining out foreign organisms and cells. Clear fluid called “lymph” flows through the lymphatic vessels and contains infection-fighting white blood cells, known as lymphocytes. The condition is a relatively aggressive type of cancer that quickly spreads throughout the body, if left untreated. Treatment modality will depend on the general health and age of the patient and how far the cancer has spread through the body. Treatments can include chemotherapy, sometimes followed by radiotherapy. Surgery is generally not recommended as a treatment option. With appropriate and timely treatment, the serious complications caused by Hodgkin’s lymphoma can be reversed.

Hodgkin’s disease can develop at any age, but is most commonly affected by people between 20 and 40 years old and those over 55 years old. It is more common in men than women and the exact cause is unknown. However, your risk of getting infected by this condition increases if you suffer from a medical condition that weakens your immune system, or you have DNA mutations or changes or if you have taken immunosuppressant medications or if you have been exposed to a common virus called Epstein-Barr virus. In addition, a person is also at high risk of developing Hodgkin’s lymphoma if a first-degree relative has had the condition. Hodgkin’s disease can be either classic Hodgkin’s disease or nodular lymphocytic predominant Hodgkin’s lymphoma (NLPHL).

There are two different types of Hodgkin’s lymphoma. Diagnosis of the specific type of lymphoma is based on the types of cells involved and their behavior. The type of lymphoma a person is diagnosed with determines their treatment options.

Classical Hodgkin’s lymphoma is a common type of lymphoma. People diagnosed with classical HD have large, abnormal cells (called Reed-Sternberg cells) in their lymph nodes.  Subtypes of classical Hodgkin’s lymphoma include –

• Nodular sclerosis Hodgkin’s lymphoma (NSHL)
• Mixed cellularity Hodgkin’s lymphoma (MCCHL)
• Lymphocyte-depleted Hodgkin’s lymphoma and
• Lymphocyte-rich Hodgkin’s lymphoma

Nodular lymphocyte-predominant Hodgkin’s lymphoma is a rare type of Hodgkin’s lymphoma. This condition involves large, abnormal cells that are sometimes called popcorn cells because of their appearance. People suffering from this type of lymphoma may have a higher chance of a cure when the disease is diagnosed at an early stage.

One of the most common symptoms associated with the condition is swelling of the lymph nodes. In most cases, this lump is not painful and may form in one or more of the following areas like – on the side of the neck, in the armpit and around the groin. Other related symptoms include –

• Unexplained weight loss
• Persistent fatigue
• Persistent cough, trouble breathing, chest pain
• Pain in the lymph nodes after consuming alcohol
• Night sweats
• Itchy skin
• Fever and
• Enlarged spleen

To diagnose Hodgkin’s disease, the physician will perform a detailed physical exam wherein they will check for swollen lymph nodes, including in the neck, underarm and groin, as well as a swollen spleen or liver. They will review the patient’s previous medical history and may be do some blood testing to analyze the complete blood count (CBC), to measure levels of red blood cells, white blood cells, and platelets and to check if anything in the patient’s blood indicates the possibility of cancer. They may order imaging tests like X-rays, CT and PET scans to look for signs of Hodgkin’s disease in other areas of the body. In addition, lung function tests and an echocardiogram may also be performed to determine how well the lungs are working. Physicians may also conduct other tests like a lymph node biopsy or bone marrow biopsy and an aspiration procedure in order to look for Hodgkin’s lymphoma cells.

Once the physician correctly determines the extent of Hodgkin’s disease cells, they will assign a specific stage for the cancer. Staging describes the extent and severity of the disease. It will also help the physician determine the patient’s prognosis and treatment options. There are four general stages of Hodgkin’s disease –

Stage 1, which is the early stage, is when cancer is found in one lymph node region or one area of a single organ.

Stage 2, which is locally advanced disease is when cancer is found in two lymph node regions (on one side of the diaphragm – which is the muscle beneath your lung), or in one lymph node region as well as in a nearby organ.

Stage 3 (advanced disease), is when cancer is found in lymph nodes both above and below the diaphragm. Cancer may also be in one portion of tissue or an organ near the lymph node groups or in the spleen.

Stage 4, which is widespread disease, is when cancer cells are found outside the lymph nodes and in several portions of one or more organs and tissues such as the bone marrow, liver, or lung.

Treatment for Hodgkin’s lymphoma typically depends on the stage of the disease. If patients don’t respond properly to chemotherapy or radiation, immunotherapy or a stem cell transplant may also be used. A stem cell transplant infuses healthy cells called stem cells into the patient’s body to replace the cancerous cells in the bone marrow. The diagnosis, screening tests and other treatment procedures performed by oncologists, radiologists or other specialists must be documented by reporting the correct medical billing codes.

I will include a transcript along with this podcast, outlining the specific coding used for Hodgkin’s lymphoma.

(ICD-10 Codes for HD

• C81.0 – Nodular lymphocyte predominant Hodgkin lymphoma
  • C81.00 – Nodular lymphocyte predominant Hodgkin lymphoma, unspecified site
  • C81.01 – Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of head, face, and neck
  • C81.02 – Nodular lymphocyte predominant Hodgkin lymphoma, intrathoracic lymph nodes
  • C81.03 – Nodular lymphocyte predominant Hodgkin lymphoma, intra-abdominal lymph nodes
  • C81.04 – Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of axilla and upper limb
  • C81.05 – Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
  • C81.06 – Nodular lymphocyte predominant Hodgkin lymphoma, intrapelvic lymph nodes
  • C81.07 – Nodular lymphocyte predominant Hodgkin lymphoma, spleen
  • C81.08 – Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of multiple sites
  • C81.09 – Nodular lymphocyte predominant Hodgkin lymphoma, extranodal and solid organ sites
• C81.1 – Nodular sclerosis Hodgkin lymphoma
  • C81.10 – Nodular sclerosis Hodgkin lymphoma, unspecified site
  • C81.11 – Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck
  • C81.12 – Nodular sclerosis Hodgkin lymphoma, intrathoracic lymph nodes
  • C81.13 – Nodular sclerosis Hodgkin lymphoma, intra-abdominal lymph nodes
  • C81.14 – Nodular sclerosis Hodgkin lymphoma, lymph nodes of axilla and upper limb
  • C81.15 – Nodular sclerosis Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
  • C81.16 – Nodular sclerosis Hodgkin lymphoma, intrapelvic lymph nodes
  • C81.17 – Nodular sclerosis Hodgkin lymphoma, spleen
  • C81.18 – Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites
  • C81.19 – Nodular sclerosis Hodgkin lymphoma, extranodal and solid organ sites

• C81.2 – Mixed cellularity Hodgkin lymphoma
  • C81.20 – Mixed cellularity Hodgkin lymphoma, unspecified site
  • C81.21 – Mixed cellularity Hodgkin lymphoma, lymph nodes of head, face, and neck
  • C81.22 – Mixed cellularity Hodgkin lymphoma, intrathoracic lymph nodes
  • C81.23 – Mixed cellularity Hodgkin lymphoma, intra-abdominal lymph nodes
  • C81.24 – Mixed cellularity Hodgkin lymphoma, lymph nodes of axilla and upper limb
  • C81.25 – Mixed cellularity Hodgkin lymphoma ,lymph nodes of inguinal region and lower limb
  • C81.26 – Mixed cellularity Hodgkin lymphoma, intrapelvic lymph nodes
  • C81.27 – Mixed cellularity Hodgkin lymphoma, spleen
  • C81.28 – Mixed cellularity Hodgkin lymphoma, lymph nodes of multiple sites
  • C81.29 – Mixed cellularity Hodgkin lymphoma, extranodal and solid organ sites

• C81.3 – Lymphocyte depleted Hodgkin lymphoma
  • C81.30 – Lymphocyte depleted Hodgkin lymphoma, unspecified site
  • C81.31 – Lymphocyte depleted Hodgkin lymphoma, lymph nodes of head, face, and neck
  • C81.32 – Lymphocyte depleted Hodgkin lymphoma, intrathoracic lymph nodes
  • C81.33 – Lymphocyte depleted Hodgkin lymphoma, intra-abdominal lymph nodes
  • C81.34 – Lymphocyte depleted Hodgkin lymphoma, lymph nodes of axilla and upper limb
  • C81.35 – Lymphocyte depleted Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
  • C81.36 – Lymphocyte depleted Hodgkin lymphoma, intrapelvic lymph nodes
  • C81.37 – Lymphocyte depleted Hodgkin lymphoma, spleen
  • C81.38 – Lymphocyte depleted Hodgkin lymphoma, lymph nodes of multiple sites
  • C81.39 – Lymphocyte depleted Hodgkin lymphoma, extranodal and solid organ sites

• C81.4 – Lymphocyte-rich Hodgkin lymphoma
  • C81.40 – Lymphocyte-rich Hodgkin lymphoma, unspecified site
  • C81.41 – Lymphocyte-rich Hodgkin lymphoma, lymph nodes of head, face, and neck
  • C81.42 – Lymphocyte-rich Hodgkin lymphoma, intrathoracic lymph nodes
  • C81.43 – Lymphocyte-rich Hodgkin lymphoma, intra-abdominal lymph nodes
  • C81.44 – Lymphocyte-rich Hodgkin lymphoma, lymph nodes of axilla and upper limb
  • C81.45 – Lymphocyte-rich Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
  • C81.46 – Lymphocyte-rich Hodgkin lymphoma, intrapelvic lymph nodes
  • C81.47 – Lymphocyte-rich Hodgkin lymphoma, spleen
  • C81.48 – Lymphocyte-rich Hodgkin lymphoma, lymph nodes of multiple sites
  • C81.49 – Lymphocyte-rich Hodgkin lymphoma, extranodal and solid organ sites

• C81.7 – Other Hodgkin lymphoma
  • C81.70 – Other Hodgkin lymphoma, unspecified site
  • C81.71 – Other Hodgkin lymphoma, lymph nodes of head, face, and neck
  • C81.72 – Other Hodgkin lymphoma, intrathoracic lymph nodes
  • C81.73 – Other Hodgkin lymphoma, intra-abdominal lymph nodes
  • C81.74 – Other Hodgkin lymphoma, lymph nodes of axilla and upper limb
  • C81.75 – Other Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
  • C81.76 – Other Hodgkin lymphoma, intrapelvic lymph nodes
  • C81.77 – Other Hodgkin lymphoma, spleen
  • C81.78 – Other Hodgkin lymphoma, lymph nodes of multiple sites
  • C81.79 – Other Hodgkin lymphoma, extranodal and solid organ sites

• C81.9 – Hodgkin lymphoma, unspecified
  • C81.90 – Hodgkin lymphoma, unspecified, unspecified site
  • C81.91 – Hodgkin lymphoma, unspecified, lymph nodes of head, face, and neck
  • C81.92 – Hodgkin lymphoma, unspecified, intrathoracic lymph nodes
  • C81.93 – Hodgkin lymphoma, unspecified, intra-abdominal lymph nodes
  • C81.94 – Hodgkin lymphoma, unspecified, lymph nodes of axilla and upper limb
  • C81.95 – Hodgkin lymphoma, unspecified, lymph nodes of inguinal region and lower limb
  • C81.96 – Hodgkin lymphoma, unspecified, intrapelvic lymph nodes
  • C81.97 – Hodgkin lymphoma, unspecified, spleen
  • C81.98 – Hodgkin lymphoma, unspecified, lymph nodes of multiple sites
  • C81.99 – Hodgkin lymphoma, unspecified, extranodal and solid organ sites)

I hope this helps. But always remember that documentation and a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank you for listening!