C81.09
BillableNodular lymphocyte predominant Hodgkin lymphoma, extranodal and solid organ sites
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C81.09 an HCC code?
Yes. C81.09 maps to Breast, Prostate, Colorectal and Other Cancers and Tumors under the CMS-HCC V28 risk adjustment model (and Lymphoma and Other Cancers under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for C81.09
For C81.09 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed C81.09 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C81.09 is the ICD-10-CM diagnosis code for nodular lymphocyte predominant hodgkin lymphoma, extranodal and solid organ sites. Hodgkin lymphoma with nodular lymphocyte predominance that involves organs or tissues outside the lymph node system, such as the liver, lungs, or bone. C81.09 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering malignant neoplasms of lymphoid, hematopoietic and related tissue (c81-c96).
Under the CMS-HCC V28 risk adjustment model, C81.09 maps to Breast, Prostate, Colorectal and Other Cancers and Tumors (HCC 21) with a community, non-dual, aged base RAF weight of 0.545. Under the older CMS-HCC V24 model, C81.09 maps to Lymphoma and Other Cancers (HCC 10) with a community, non-dual, aged base RAF weight of 0.675. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Use this code for extranodal involvement (organs/tissues other than lymph nodes). Because C81.09 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for C81.09 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code for extranodal involvement (organs/tissues other than lymph nodes)
- •Document the specific extranodal site(s) involved in the clinical record for staging purposes
Clinical Significance
Nodular lymphocyte predominant Hodgkin lymphoma involving extranodal and solid organ sites indicates disease extending beyond the lymph node system into organs such as the liver, lungs, bone marrow, or other solid tissues. Extranodal involvement in NLPHL is uncommon and may indicate Stage IV disease or transformation to a more aggressive lymphoma. This presentation warrants thorough evaluation including consideration of large-cell transformation.
Documentation Requirements
- ✓Pathology confirming NLPHL subtype in the extranodal site
- ✓Specific extranodal organ(s) involved clearly documented
- ✓Biopsy of the extranodal site if possible to confirm NLPHL versus transformation to diffuse large B-cell lymphoma
- ✓Ann Arbor staging with 'E' suffix designation for extranodal extension
- ✓Bone marrow biopsy results
- ✓Assessment for large-cell transformation