C84.04
BillableMycosis fungoides, lymph nodes of axilla and upper limb
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C84.04 an HCC code?
Yes. C84.04 maps to Lung and Other Severe Cancers 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 C84.04
For C84.04 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 C84.04 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C84.04 is the ICD-10-CM diagnosis code for mycosis fungoides, lymph nodes of axilla and upper limb. A rare type of skin cancer (mycosis fungoides) that has spread to the lymph nodes in the armpits and upper arms. C84.04 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, C84.04 maps to Lung and Other Severe Cancers (HCC 20) with a community, non-dual, aged base RAF weight of 0.000. Under the older CMS-HCC V24 model, C84.04 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.
Document axillary and upper limb lymph node involvement through physical exam or imaging. Because C84.04 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 C84.04 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document axillary and upper limb lymph node involvement through physical exam or imaging
- •The '4' designator specifically indicates axillary and upper extremity lymph nodes
Clinical Significance
Mycosis fungoides with involvement of axillary and upper limb lymph nodes indicates disease progression beyond the skin. Axillary lymphadenopathy in mycosis fungoides patients may be reactive (dermatopathic) or represent true lymphomatous involvement, and pathologic distinction is important for accurate staging. True lymph node involvement indicates Stage III-IV disease requiring systemic treatment.
Documentation Requirements
- ✓Skin biopsy confirming mycosis fungoides
- ✓Axillary lymph node biopsy or imaging confirming involvement
- ✓Distinction between dermatopathic lymphadenopathy and lymphomatous involvement
- ✓TNMB staging
- ✓Treatment plan reflecting nodal disease