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C81.04 ICD-10-CM Code: Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of axilla and upper limb

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 Excludes1 · 4 Excludes2
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 10 · RxHCC V08 category 21

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 820 — LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC (MDC 17)
  • MS-DRG 821 — LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC (MDC 17)
  • MS-DRG 822 — LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC (MDC 17)
  • MS-DRG 823 — LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC (MDC 17)
  • MS-DRG 824 — LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC (MDC 17)
  • MS-DRG 825 — LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC (MDC 17)
  • MS-DRG 840 — LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC (MDC 17)
  • MS-DRG 841 — LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC (MDC 17)
  • MS-DRG 842 — LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC (MDC 17)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 21 — Lymphoma and Other Cancers (supersedes HCC 22, HCC 23)

Other models: CMS-HCC V22 HCC 10 · RxHCC V08 HCC 21

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for C81.04 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on C81.04 itself; “inherited from” names the category or block whose note applies here.

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from C81

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Source: inherited from C81-C96

Coder workflow for C81.04

MedCoder structured workflow — derived from this code’s own official record

Before you code C81.04

  1. Confirm the documented site and behavior (this code’s block classifies malignant neoplasms), whether the site is primary or secondary, and whether the malignancy is current or a personal history: a previously excised malignancy with no further treatment and no evidence of disease is history, not current disease. Verify the site against the Table of Neoplasms. Neoplasm chapter guidelines (Guidelines I.C.2.a, I.C.2.d, I.C.2.m).

    See the Table of Neoplasms entries · Guide: Active cancer vs history of cancer →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with C81.04. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in C81.04’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewZ85.71

Consider C81.04. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Anatomical site
At the most specific level the record states; a site the classification separates cannot be assumed from a procedure or a measurement.
Behavior and current-versus-history status
Malignant, in situ, benign or uncertain; primary or secondary; current disease or personal history (Guidelines I.C.2.m).

Official instructions as workflow

  • Excludes1 — check before selecting C81.04(1 note)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with C81.04: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareZ85.71

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of C81.04(4 notes)

    Coding workflow: The conditions named in this note are not included in C81.04. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareC46.3, C77, C79.52, C78.89

    See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition C81.04 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewZ85.71

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of axilla and upper limb is a billable ICD-10-CM diagnosis code (C81.04).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Chapter 2: Neoplasms (C00-D49 )

t. Secondary malignant neoplasm of lymphoid tissue When a malignant neoplasm of lymphoid tissue metastasizes beyond the lymph nodes, a code from categories C81-C85 with a final character identifying “extranodal and solid organ sites” should be assigned rather than a code for the secondary neoplasm of the affected solid organ. For example, for metastasis of diffuse large B-cell lymphoma to the lung, brain and left adrenal gland, assign code C83.398, Diffuse large B-cell lymphoma of other extranodal and solid organ sites.

Verify Before Coding

  • CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name C81.04 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 4 Excludes1 notes: C26.1 — Malignant neoplasm of spleen (via C81.-), C76 — Malignant neoplasm of other and ill-defined sites (via C81.-), C77 — Secondary and unspecified malignant neoplasm of lymph nodes (via C81.-), C81.4 — Lymphocyte-rich Hodgkin lymphoma (via C81.0.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 2 Code First instructions across 2 chapters: N16 — Renal tubulo-interstitial disorders in diseases classified elsewhere (via C81.-), Z15.0 — Genetic susceptibility to malignant neoplasm (via C81.-).

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 80 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 9 MS-DRGs: DRG 820 (MDC 17), DRG 821 (MDC 17), DRG 822 (MDC 17), DRG 823 (MDC 17), DRG 824 (MDC 17), DRG 825 (MDC 17), DRG 840 (MDC 17), DRG 841 (MDC 17), DRG 842 (MDC 17).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):NEO057 — Hodgkin lymphoma (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

C81.00 — Nodular lymphocyte predominant Hodgkin lymphoma, unspecified site, C81.01 — Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of head, face, and neck, C81.02 — Nodular lymphocyte predominant Hodgkin lymphoma, intrathoracic lymph nodes, C81.03 — Nodular lymphocyte predominant Hodgkin lymphoma, intra-abdominal lymph nodes, C81.05 — Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of inguinal region and lower limb, C81.06 — Nodular lymphocyte predominant Hodgkin lymphoma, intrapelvic lymph nodes, C81.07 — Nodular lymphocyte predominant Hodgkin lymphoma, spleen, C81.08 — Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of multiple sites, C81.09 — Nodular lymphocyte predominant Hodgkin lymphoma, extranodal and solid organ sites, C81.0A — Nodular lymphocyte predominant Hodgkin lymphoma, in remission, C81.10 — Nodular sclerosis Hodgkin lymphoma, unspecified site, C81.11 — Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck, C81.12 — Nodular sclerosis Hodgkin lymphoma, intrathoracic lymph nodes, C81.13 — Nodular sclerosis Hodgkin lymphoma, intra-abdominal lymph nodes, C81.14 — Nodular sclerosis Hodgkin lymphoma, lymph nodes of axilla and upper limb, C81.15 — Nodular sclerosis Hodgkin lymphoma, lymph nodes of inguinal region and lower limb, C81.16 — Nodular sclerosis Hodgkin lymphoma, intrapelvic lymph nodes, C81.17 — Nodular sclerosis Hodgkin lymphoma, spleen, C81.18 — Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites, C81.19 — Nodular sclerosis Hodgkin lymphoma, extranodal and solid organ sites, +59 more

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Lymphoma and Other Cancers) for risk-adjusted payment.

C7A.094 — Malignant carcinoid tumor of the foregut, unspecified, C7A.095 — Malignant carcinoid tumor of the midgut, unspecified, C7A.096 — Malignant carcinoid tumor of the hindgut, unspecified, C7A.098 — Malignant carcinoid tumors of other sites, C7A.1 — Malignant poorly differentiated neuroendocrine tumors, C7A.8 — Other malignant neuroendocrine tumors, C81.00 — Nodular lymphocyte predominant Hodgkin lymphoma, unspecified site, C81.01 — Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of head, face, and neck, C81.02 — Nodular lymphocyte predominant Hodgkin lymphoma, intrathoracic lymph nodes, C81.03 — Nodular lymphocyte predominant Hodgkin lymphoma, intra-abdominal lymph nodes, C81.05 — Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of inguinal region and lower limb, C81.06 — Nodular lymphocyte predominant Hodgkin lymphoma, intrapelvic lymph nodes, C81.07 — Nodular lymphocyte predominant Hodgkin lymphoma, spleen, C81.08 — Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of multiple sites, C81.09 — Nodular lymphocyte predominant Hodgkin lymphoma, extranodal and solid organ sites, C81.0A — Nodular lymphocyte predominant Hodgkin lymphoma, in remission, C81.10 — Nodular sclerosis Hodgkin lymphoma, unspecified site, C81.11 — Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck, C81.12 — Nodular sclerosis Hodgkin lymphoma, intrathoracic lymph nodes, C81.13 — Nodular sclerosis Hodgkin lymphoma, intra-abdominal lymph nodes, +442 more

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic, Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid, Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers, Lung and Other Severe Cancers, Bladder, Colorectal, and Other Cancers, Prostate, Breast, and Other Cancers and Tumors

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Hodgkin lymphoma).

C81.00 — Nodular lymphocyte predominant Hodgkin lymphoma, unspecified site, C81.01 — Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of head, face, and neck, C81.02 — Nodular lymphocyte predominant Hodgkin lymphoma, intrathoracic lymph nodes, C81.03 — Nodular lymphocyte predominant Hodgkin lymphoma, intra-abdominal lymph nodes, C81.05 — Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of inguinal region and lower limb, C81.06 — Nodular lymphocyte predominant Hodgkin lymphoma, intrapelvic lymph nodes, C81.07 — Nodular lymphocyte predominant Hodgkin lymphoma, spleen, C81.08 — Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of multiple sites, C81.09 — Nodular lymphocyte predominant Hodgkin lymphoma, extranodal and solid organ sites, C81.10 — Nodular sclerosis Hodgkin lymphoma, unspecified site, C81.11 — Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck, C81.12 — Nodular sclerosis Hodgkin lymphoma, intrathoracic lymph nodes, C81.13 — Nodular sclerosis Hodgkin lymphoma, intra-abdominal lymph nodes, C81.14 — Nodular sclerosis Hodgkin lymphoma, lymph nodes of axilla and upper limb, C81.15 — Nodular sclerosis Hodgkin lymphoma, lymph nodes of inguinal region and lower limb, C81.16 — Nodular sclerosis Hodgkin lymphoma, intrapelvic lymph nodes, C81.17 — Nodular sclerosis Hodgkin lymphoma, spleen, C81.18 — Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites, C81.19 — Nodular sclerosis Hodgkin lymphoma, extranodal and solid organ sites, C81.20 — Mixed cellularity Hodgkin lymphoma, unspecified site, +49 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Lymphoma”; these codes share that main term but sit in a different category of the Tabular List.

C82.0 — Follicular lymphoma grade I (follicular, grade, I), C82.1 — Follicular lymphoma grade II (follicular, grade, II), C82.2 — Follicular lymphoma grade III, unspecified (follicular, grade, III), C82.3 — Follicular lymphoma grade IIIa (follicular, grade, IIIa), C82.4 — Follicular lymphoma grade IIIb (follicular, grade, IIIb), C82.5 — Diffuse follicle center lymphoma (diffuse follicle center), C82.6 — Cutaneous follicle center lymphoma (cutaneous follicle center), C82.8 — Other types of follicular lymphoma (follicular, specified NEC), C82.9 — Follicular lymphoma, unspecified (follicular), C83.0 — Small cell B-cell lymphoma (small cell B-cell), C83.1 — Mantle cell lymphoma (mantle cell), C83.3 — Diffuse large B-cell lymphoma (diffuse large cell), C83.390 — Primary central nervous system lymphoma (primary central nervous system), C83.398 — Diffuse large B-cell lymphoma of other extranodal and solid organ sites (diffuse large cell, extranodal and solid organ sites NEC), C83.5 — Lymphoblastic (diffuse) lymphoma (B-precursor), C83.59 — Lymphoblastic (diffuse) lymphoma, extranodal and solid organ sites (primary central nervous system, lymphoblastic), C83.7 — Burkitt lymphoma (Burkitt), C83.79 — Burkitt lymphoma, extranodal and solid organ sites (primary central nervous system, Burkitt), C83.8 — Other non-follicular lymphoma (primary effusion B-cell), C83.9 — Non-follicular (diffuse) lymphoma, unspecified (non-follicular), +25 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Gamma-glutamyl Transferase (GGT) Test, HIV Screening Test, Iron Panel

Contextual Map

Every relationship of C81.04 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run C81.04 with these 6 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Code First instructions

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 21 — Lymphoma and Other Cancers [CMS-HCC]: “Lymphoma and Other Cancers — supersedes HCC 22 (Bladder, Colorectal, and Other Cancers), HCC 23 (Prostate, Breast, and Other Cancers and Tumors)”— CMS-HCC V28 · 2026

MS-DRG Grouper (9)

MDC crossing

  • MDC 17 — Myeloproliferative Diseases and Disorders, Poorly Differentiated Neoplasms[MDC crossing]: “Myeloproliferative Diseases and Disorders, Poorly Differentiated Neoplasms — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 4,730 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Nearest codes (40)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "C81.04 — Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of axilla and upper limb." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/c81.04-nodular-lymphocyte-predominant-hodgkin-lymphoma-lymph-nodes-of-axilla-and-upper-limb

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of axilla and upper limb

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to C81.04 in its code family, with their registry titles.

View all codes in the C81 family