General Surgery Coding Alert

Question: Our surgeon performed a fine-needle aspiration of the spleen for a patient diagnosed with non-Hodgkin’s lymphoma. The pathology report noted an “intrafollicular growth pattern suggestive of follicular lymphoma,” and stated that the specimen was sent to an outside lab for further cytogenetic testing. Should we report the diagnosis as C85.90 since we don’t have a confirmed diagnosis from the pathology report?

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Answer: For this situation, the best code choice is C85.99 (Non-Hodgkin lymphoma, unspecified, extranodal and solid organ sites) rather than the code you suggested (C85.90, Non-Hodgkin lymphoma, unspecified, unspecified site).

You are correct that you shouldn’t code follicular lymphoma (C82.97, Follicular lymphoma, unspecified, spleen), because that diagnosis is not confirmed in this pathology report.

The big giveaway that you want to use C85.99 instead of C85.90 is the specificity of its definition. Remember to be as specific as possible whenever you code.

There are two things that make C85.99 more specific than the code you wanted to use. First, C85.90 does not indicate the site. In your case, you know that you are coding for the spleen, which is a “solid organ.” The spleen is also outside of lymph nodes, which makes it an “extranodal” site.

The best information for this case satisfies these two specific conditions (solid organ and extranodal) that validate use of code C85.99 instead of C85.90.

Don’t forget: Code C85.99 is one of those codes that require a sixth and seventh character. The sixth character will indicate laterality (right side, left side, bilateral, or unspecified), and the seventh character will indicate which encounter this is (initial, subsequent, or sequelae).