Oncology & Hematology Coding Alert

Question: What is the correct coding for testicular lymphoma? I have always been told to code any reproductive organ cancer to the disease site, but I am unsure when it comes to lymphoma. This is diffuse large B-cell lymphoma. I have referred to the official guidelines, and can’t find any specific guidance.

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Answer: In this particular situation, you won’t find the patient’s condition listed under lymphoma, testicular, in the ICD-10-CM Alphabetic Index. Instead, to find the correct code for the condition, you’ll follow these three steps.

First, in ICD-10-CM, begin by choosing the parent code by lymphoma type. In your particular case, the patient has diffuse large B-cell lymphoma, or DLBCL, which can be located under the main term lymphoma, specifically C83.3- (Diffuse large B-cell lymphoma).

Second, you then have to pinpoint the location of the specific lymph node affected or the body part to which the lymphoma has metastasized. This is done with a fifth character, indicated for most lymphoma codes in ICD-10-CM as follows:

0 - unspecified site
1 - lymph nodes of head, face, and neck
2 - intrathoracic lymph nodes
3 - intra-abdominal lymph nodes
4 - lymph nodes of axilla and upper limb
5 - lymph nodes of inguinal region and lower limb
6 - intrapelvic lymph nodes
7 - spleen
8 - lymph nodes of multiple sites
9 - extranodal and solid organ sites

To choose the correct fifth character, you’ll follow ICD-10-CM guideline I.C.2.t. This tells you “when a malignant neoplasm of lymphoid tissue metastasizes beyond the lymph nodes, a code from categories C81-C85 with a final character ‘9’ should be assigned identifying ‘extranodal and solid organ sites’ rather than a code for the secondary neoplasm of the affected solid organ.”

So, as the provider has specified the DLBCL site, and you know that the lymphoma is no longer in the patient’s lymph nodes but has metastasized to a specified site that is not the patient’s spleen, you’ll use C83.39 (Diffuse large B-cell lymphoma, extranodal and solid organ sites).