C85.96
BillableNon-Hodgkin lymphoma, unspecified, intrapelvic lymph nodes
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C85.96 an HCC code?
Yes. C85.96 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 C85.96
For C85.96 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 C85.96 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C85.96 is the ICD-10-CM diagnosis code for non-hodgkin lymphoma, unspecified, intrapelvic lymph nodes. This code describes a type of cancer affecting the lymph nodes located in the pelvis (lower abdomen area) where the specific type of non-Hodgkin lymphoma has not been identified or specified. Non-Hodgkin lymphoma is a cancer of the immune system that starts in lymph nodes. C85.96 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, C85.96 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, C85.96 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.
Verify documentation specifies the lymph node location as intrapelvic; if lymph nodes in other locations are also involved, additional codes may be needed for each site. Because C85.96 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 C85.96 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation specifies the lymph node location as intrapelvic; if lymph nodes in other locations are also involved, additional codes may be needed for each site
- •This 'unspecified' code should only be used when the pathology report does not provide enough detail to assign a more specific non-Hodgkin lymphoma subtype; query the provider if additional histological information is available
Clinical Significance
Non-Hodgkin lymphoma of unspecified type affecting intrapelvic lymph nodes involves deep nodal groups including iliac, obturator, and sacral lymph nodes. Intrapelvic lymphoma may be clinically silent until it reaches a size sufficient to compress adjacent pelvic structures, potentially causing urinary or bowel symptoms. This deep location typically requires cross-sectional imaging for detection and CT-guided biopsy for tissue diagnosis.
Documentation Requirements
- ✓Documentation must specify intrapelvic lymph node involvement as confirmed by imaging (CT, MRI, or PET-CT).
- ✓Provider should attempt to identify the specific NHL subtype through biopsy and immunohistochemistry.
- ✓Treatment plan, staging results, disease status, and any compressive symptoms must be recorded.
Commonly Confused Codes
- •C85.93 (intra-abdominal lymph nodes) involves nodes above the pelvic brim.
- •C85.95 (inguinal region and lower limb) covers superficial groin nodes, not deep pelvic nodes.
- •C79.89 (secondary malignant neoplasm of other specified sites) should be considered if the pelvic nodal disease is metastatic from another primary.