C85.97
BillableNon-Hodgkin lymphoma, unspecified, spleen
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C85.97 an HCC code?
Yes. C85.97 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 C85.97
For C85.97 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 C85.97 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C85.97 is the ICD-10-CM diagnosis code for non-hodgkin lymphoma, unspecified, spleen. Non-Hodgkin lymphoma of unspecified type affecting the spleen. C85.97 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, C85.97 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, C85.97 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.
The spleen is an extranodal site; confirm splenic involvement is documented. Because C85.97 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 C85.97 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •The spleen is an extranodal site; confirm splenic involvement is documented
- •Splenic involvement may occur with or without lymph node involvement
Clinical Significance
Non-Hodgkin lymphoma of unspecified type involving the spleen represents an extranodal presentation with significant implications for immune function and disease staging. Splenic involvement often manifests as splenomegaly detectable on physical examination or imaging, and may cause cytopenias through hypersplenism. Splenic lymphoma can be the predominant site of disease or part of a more disseminated process.
Documentation Requirements
- ✓Provider must document splenic involvement through imaging (CT, PET-CT, or ultrasound showing splenomegaly or focal lesions) or pathology from splenectomy specimens.
- ✓The specific NHL subtype should be sought through tissue analysis.
- ✓Disease stage, treatment plan, spleen size measurements, and associated cytopenias should be recorded.