C81.49 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 · HCC Buddy coding tools

ICD-10-CM Code View

HCC Buddy Code Card

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Code lookupC81.49

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

C81.49

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

Lymphocyte-rich Hodgkin lymphoma, extranodal and solid organ sites

This is a type of Hodgkin lymphoma (a cancer of the lymph system) where lymphocytes are the predominant cancer cells, and the cancer is found in organs or tissues outside the lymph nodes. This represents an advanced stage of the disease affecting solid organs or extranodal sites.

Buddy Insight

Lymphocyte-rich Hodgkin lymphoma with extranodal and solid organ involvement indicates stage IV disease even within this favorable-prognosis subtype.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 21

Lymphoma and Other Cancers

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

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 012

HHS-HCC 012 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 10

Lymphoma and Other Cancers

Code-level coefficient reference

RXHCC

Mapped

HCC 21

Lymphomas and Other Hematolog...

Code-level coefficient reference

Code Book Path

Official

C81Hodgkin lymphoma C81.4Lymphocyte-rich Hodgkin lymphoma C81.49Lymphocyte-rich Hodgkin lymphoma, extranodal and solid organ sites

Inclusion Terms

Official

Lymphocyte-rich classical Hodgkin lymphomaInherited from C81.4

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

C81.40Lymphocyte-rich Hodgkin lymphoma, unspecified site C81.41Lymphocyte-rich Hodgkin lymphoma, lymph nodes of head, face, and neck C81.42Lymphocyte-rich Hodgkin lymphoma, intrathoracic lymph nodes C81.43Lymphocyte-rich Hodgkin lymphoma, intra-abdominal lymph nodes C81.44Lymphocyte-rich Hodgkin lymphoma, lymph nodes of axilla and upper limb

Includes

Official

No Includes notes are included in this display for C81.49. Check the code and parent instructions in the Code Book.

Excludes 1

Official

personal history of Hodgkin lymphoma (Z85.71)Inherited from C81, C81.4
nodular lymphocyte predominant Hodgkin lymphoma (C81.0-)Inherited from C81, C81.4

Code First

Official

No Code First sequencing instructions are included in this display for C81.49. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for C81.49. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for C81.49. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Pathology confirming lymphocyte-rich Hodgkin lymphoma

Documentation of specific extranodal organ(s) involved with imaging or biopsy confirmation

Bone marrow biopsy results when marrow involvement is clinically suspected

Stage IV Ann Arbor designation

MEAT Support

HCC Buddy guidance

Pathology confirming lymphocyte-rich Hodgkin lymphoma

Documentation of specific extranodal organ(s) involved with imaging or biopsy confirmation

Bone marrow biopsy results when marrow involvement is clinically suspected

Stage IV Ann Arbor designation

Audit Caution

HCC Buddy guidance

Using secondary neoplasm codes (C77-C79) for lymphomatous organ involvement instead of the primary lymphoma code

Coding C81.49 for splenic disease when C81.47 is the specific code for the spleen

Failing to document which specific extranodal organs are affected

Not verifying the pathologic subtype when coding — lymphocyte-rich must be confirmed to use this code

Common Mistakes

HCC Buddy guidance

C81.47 — Lymphocyte-rich Hodgkin lymphoma, spleen: splenic involvement has its own code; do not use C81.49 for isolated splenic disease

C81.48 — Lymphocyte-rich Hodgkin lymphoma, multiple node sites: C81.48 is for multiple lymph node regions; C81.49 is for non-nodal organ involvement

C78/C79 — Secondary malignant neoplasm codes: do not use these for lymphoma organ involvement — lymphoma is coded as primary at all sites

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 C81.49 an HCC code?

Yes. C81.49 (Lymphocyte-rich Hodgkin lymphoma, extranodal and solid organ 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: C81.49 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: C81.49
Description: Lymphocyte-rich Hodgkin lymphoma, extranodal and solid organ 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 C81.49 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for C81.49

For C81.49, 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

C81.49 is the ICD-10-CM diagnosis code for lymphocyte-rich hodgkin lymphoma, extranodal and solid organ sites. This is a type of Hodgkin lymphoma (a cancer of the lymph system) where lymphocytes are the predominant cancer cells, and the cancer is found in organs or tissues outside the lymph nodes. This represents an advanced stage of the disease affecting solid organs or extranodal sites. C81.49 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, C81.49 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.

Verify the pathology report confirms 'lymphocyte-rich' subtype and documents involvement of extranodal or solid organ sites to support this specific code selection. For C81.49, 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 C81.49 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Verify the pathology report confirms 'lymphocyte-rich' subtype and documents involvement of extranodal or solid organ sites to support this specific code selection
•This code requires documentation of the specific site(s) affected; ensure the primary site is clearly identified in the medical record before assigning this code

Clinical Significance

Lymphocyte-rich Hodgkin lymphoma with extranodal and solid organ involvement indicates stage IV disease even within this favorable-prognosis subtype. Organ involvement (liver, lung, bone, bone marrow) requires intensified treatment and closer monitoring. The lymphocyte-rich histology may still predict relatively favorable outcomes compared to other subtypes with similar staging.

Documentation Requirements

✓Pathology confirming lymphocyte-rich Hodgkin lymphoma
✓Documentation of specific extranodal organ(s) involved with imaging or biopsy confirmation
✓Bone marrow biopsy results when marrow involvement is clinically suspected
✓Stage IV Ann Arbor designation
✓Active treatment plan and encounter-specific provider assessment

Commonly Confused Codes

•C81.47: Lymphocyte-rich Hodgkin lymphoma, spleen: splenic involvement has its own code; do not use C81.49 for isolated splenic disease
•C81.48: Lymphocyte-rich Hodgkin lymphoma, multiple node sites: C81.48 is for multiple lymph node regions; C81.49 is for non-nodal organ involvement
•C78/C79: Secondary malignant neoplasm codes: do not use these for lymphoma organ involvement: lymphoma is coded as primary at all sites