C85.86
BillableOther specified types of non-Hodgkin lymphoma, intrapelvic lymph nodes
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C85.86 an HCC code?
Yes. C85.86 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 C85.86
For C85.86 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 C85.86 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C85.86 is the ICD-10-CM diagnosis code for other specified types of non-hodgkin lymphoma, intrapelvic lymph nodes. A rare or unusual type of non-Hodgkin lymphoma affecting lymph nodes located within the pelvis. C85.86 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, C85.86 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, C85.86 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.
Intrapelvic lymph nodes include iliac, obturator, and other pelvic lymph nodes. Because C85.86 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 C85.86 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Intrapelvic lymph nodes include iliac, obturator, and other pelvic lymph nodes
- •Ensure imaging or pathology documentation confirms pelvic lymph node involvement
Clinical Significance
Other specified non-Hodgkin lymphoma involving intrapelvic lymph nodes captures rare, named NHL subtypes at a defined anatomical location. Accurate site-specific coding supports treatment planning, radiation field design, and outcomes tracking. These lymphoma subtypes often have distinct clinical behaviors and treatment requirements compared to common NHL types.
Documentation Requirements
- ✓Pathology confirming the specific NHL subtype by WHO classification (with immunophenotyping and molecular studies)
- ✓Imaging or clinical documentation confirming involvement of intrapelvic lymph nodes
- ✓Verification that no more specific ICD-10 code exists for this NHL subtype
- ✓Staging information and treatment plan
Commonly Confused Codes
- •C85.80 (Other specified NHL, unspecified site) — Use the site-specific code when intrapelvic lymph nodes is documented
- •C83.x or C82.x (specific NHL subtypes at same site) — Verify the subtype does not have its own code in C82-C84 or C86
- •C85.88 (Other specified NHL, lymph nodes of multiple sites) — Use site-specific code for single-site involvement; use C85.88 for multiple regions