VIDEO HERE

VIDEO HERE

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

6

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

35

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

36

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.

48

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