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C81.18 ICD-10-CM Code: Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites

C81.18 maps to CMS-HCC V28 21. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

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Code lookupC81.18

FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neoplasms of lymphoid, hematopoietic and related tissue (C81-C96)

C81.18

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites

A type of Hodgkin lymphoma with nodular sclerosis pattern affecting lymph nodes in multiple different areas of the body.

Buddy the Bee presenting code insight

Buddy Insight

Nodular sclerosis Hodgkin lymphoma of multiple lymph node sites indicates disease in two or more distinct anatomic lymph node regions, commonly cervical plus mediastinal or cervical plus axillary.

OverviewRisk ModelsCode BookDocumentationAuditNotesEdition comparison

CMS-HCC V28

HCC 21

Coefficient HCC 21: 0.671 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

HCC 012

Code-level coefficient reference

ESRD/PACE

HCC 10

Code-level coefficient reference

RXHCC

HCC 21

Code-level coefficient reference

Code Book Path

Official
C81Hodgkin lymphomaC81.1Nodular sclerosis Hodgkin lymphomaC81.18Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites

Inclusion Terms

Official
  • Nodular sclerosis classical Hodgkin lymphomaInherited from C81.1

Excludes 2

Official
  • Kaposi's sarcoma of lymph nodes (C46.3)Inherited from C81-C96
  • secondary and unspecified neoplasm of lymph nodes (C77.-)Inherited from C81-C96
  • secondary neoplasm of bone marrow (C79.52)Inherited from C81-C96
  • secondary neoplasm of spleen (C78.89)Inherited from C81-C96

Related Codes

Official
C81.10Nodular sclerosis Hodgkin lymphoma, unspecified siteC81.11Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neckC81.12Nodular sclerosis Hodgkin lymphoma, intrathoracic lymph nodesC81.13Nodular sclerosis Hodgkin lymphoma, intra-abdominal lymph nodesC81.14Nodular sclerosis Hodgkin lymphoma, lymph nodes of axilla and upper limb

Includes

Official

No Includes notes are included in this display for C81.18. Check the code and parent instructions in the Code Book.

Excludes 1

Official
  • personal history of Hodgkin lymphoma (Z85.71)Inherited from C81

Code First

Official

No Code First sequencing instructions are included in this display for C81.18. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for C81.18. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for C81.18. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance
Pathology confirming nodular sclerosis subtype
Documentation of at least two distinct lymph node regions involved
PET/CT showing all involved lymph node sites
Specific listing of all affected lymph node regions

MEAT Support

HCC Buddy guidance
Pathology confirming nodular sclerosis subtype
Documentation of at least two distinct lymph node regions involved
PET/CT showing all involved lymph node sites
Specific listing of all affected lymph node regions

Audit Caution

HCC Buddy guidance
Confusing 'multiple sites' with 'unspecified site' — these are distinct concepts
Using single-site codes when disease involves more than one anatomic region
Not documenting all involved regions even though the code captures 'multiple sites' generically
Failing to recognize that cervical plus supraclavicular nodes may represent one region, not multiple

Common Mistakes

HCC Buddy guidance
C81.11-C81.17 — Single site nodular sclerosis codes: Use when only one lymph node region is involved
C81.19 — Nodular sclerosis, extranodal: Use for organ involvement, not multiple lymph node sites
C81.10 — Nodular sclerosis, unspecified site: Not interchangeable with C81.18; unspecified means unknown, multiple means two or more known regions
C81.08 — NLPHL, multiple sites: Different subtype

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is C81.18 an HCC code?

Yes. C81.18 (Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites) maps to HCC 21, Lymphoma and Other Cancers under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.671. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: C81.18 is billable and maps to V28 HCC 21, Lymphoma and Other Cancers. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
C81.18
Description
Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites
HCC (V28)
HCC 21 — Lymphoma and Other Cancers
RAF reference coefficient
0.671
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 21, Lymphoma and Other Cancers
0.671
ESRDHCC 10, Lymphoma and Other Cancers
Not separately weighted
RxHCCHCC 21, Lymphomas and Other Hematologic Cancers
Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work C81.18 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for C81.18

For C81.18, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

  • 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

Coder workflow notes

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What This Code Means

C81.18 is the ICD-10-CM diagnosis code for nodular sclerosis hodgkin lymphoma, lymph nodes of multiple sites. A type of Hodgkin lymphoma with nodular sclerosis pattern affecting lymph nodes in multiple different areas of the body. C81.18 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, C81.18 maps to Lymphoma and Other Cancers (HCC 21) with a source-labeled community, non-dual, aged reference coefficient of 0.671. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Character '8' indicates involvement of multiple lymph node sites; document all affected regions in clinical notes. For C81.18, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for C81.18 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Character '8' indicates involvement of multiple lymph node sites; document all affected regions in clinical notes
  • •Add seventh character extension for encounter type and remission status

Clinical Significance

Nodular sclerosis Hodgkin lymphoma of multiple lymph node sites indicates disease in two or more distinct anatomic lymph node regions, commonly cervical plus mediastinal or cervical plus axillary. This is a very common presentation for nodular sclerosis Hodgkin lymphoma, which frequently involves contiguous lymph node regions. Multi-site involvement affects Ann Arbor staging and treatment intensity.

Documentation Requirements

  • ✓Pathology confirming nodular sclerosis subtype
  • ✓Documentation of at least two distinct lymph node regions involved
  • ✓PET/CT showing all involved lymph node sites
  • ✓Specific listing of all affected lymph node regions
  • ✓Ann Arbor staging (Stage II or higher for multiple regions)
  • ✓Treatment plan appropriate for the extent of disease

Commonly Confused Codes

  • •C81.11-C81.17: Single site nodular sclerosis codes: Use when only one lymph node region is involved
  • •C81.19: Nodular sclerosis, extranodal: Use for organ involvement, not multiple lymph node sites
  • •C81.10: Nodular sclerosis, unspecified site: Not interchangeable with C81.18; unspecified means unknown, multiple means two or more known regions
  • •C81.08: NLPHL, multiple sites: Different subtype

Child Codes

C81.10Nodular sclerosis Hodgkin lymphoma, unspecified site
HCC 21
C81.11Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck
HCC 21
C81.12Nodular sclerosis Hodgkin lymphoma, intrathoracic lymph nodes
HCC 21
C81.13Nodular sclerosis Hodgkin lymphoma, intra-abdominal lymph nodes
HCC 21
C81.14Nodular sclerosis Hodgkin lymphoma, lymph nodes of axilla and upper limb
HCC 21
C81.15Nodular sclerosis Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
HCC 21
C81.16Nodular sclerosis Hodgkin lymphoma, intrapelvic lymph nodes
HCC 21
C81.17Nodular sclerosis Hodgkin lymphoma, spleen
HCC 21
C81.18Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites
HCC 21
C81.19Nodular sclerosis Hodgkin lymphoma, extranodal and solid organ sites
HCC 21
C81.1ANodular sclerosis Hodgkin lymphoma, in remission
HCC 21

Code Hierarchy

└C81Hodgkin lymphoma└C81.1Nodular sclerosis Hodgkin lymphoma└C81.18Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites
└C81.18Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites

C81.18 code history

Code setChange
FY2017 (effective Oct 1, 2016)Description revised

Source: official CMS ICD-10-CM order and addenda files, FY2016 through FY2027.

Also searched as

  • C81 18
  • C8118

For C81.18, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

C81.18 maps to CMS-HCC V28 category 21, Lymphoma and Other Cancers. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. The mapping identifies a payment HCC category for C81.18. Review its source-labeled HCC coefficient above, check the RAF Calculator with complete member context for CMS-HCC V28 PY2026, and confirm the documentation the chart needs before the code is submitted. HCC Buddy shows no RAF score unless every required source and calculation check passes.

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Open C81.18 in the Code Book for the full Index-to-Tabular path, MEAT checklist, and V28 HCC mapping, or in the Encoder to code from a keyword search. Pro includes 7 days to try everything, no card required.

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