C86.01
BillableExtranodal NK/T-cell lymphoma, nasal type, in remission
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C86.01 an HCC code?
Yes. C86.01 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 C86.01
For C86.01 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 C86.01 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C86.01 is the ICD-10-CM diagnosis code for extranodal nk/t-cell lymphoma, nasal type, in remission. A rare type of lymphoma affecting the nose and nasal passages caused by abnormal NK/T-cells that is currently in remission. C86.01 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, C86.01 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, C86.01 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.
Only use when documentation explicitly states remission status. Because C86.01 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 C86.01 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Only use when documentation explicitly states remission status
- •Ensure remission is confirmed by clinical assessment or imaging
Clinical Significance
Extranodal NK/T-cell lymphoma, nasal type in remission indicates this rare aggressive lymphoma has responded to treatment with no currently detectable disease activity. Given the aggressive nature and high relapse rate of this lymphoma subtype, remission represents a significant clinical milestone. Ongoing surveillance with imaging and Epstein-Barr virus DNA monitoring is essential due to the substantial risk of relapse.
Documentation Requirements
- ✓Provider must explicitly document remission status, supported by imaging studies showing no residual disease and normalization of Epstein-Barr virus DNA levels.
- ✓The original diagnosis of NK/T-cell lymphoma nasal type must be confirmed in the record.
- ✓Surveillance schedule and any treatment-related complications should be documented.
Commonly Confused Codes
- •C86.00 (same lymphoma not in remission) indicates active disease.
- •Z85.79 (personal history of malignant neoplasms of lymphoid tissue) should only be used when the disease is considered cured and no longer under oncologic surveillance.
- •Other T-cell lymphoma codes in the C86.x category represent different entities.