Abstracting Keys

Casefinding in medical records is based on ICD-9-CM codes. ICD-O morphology terms are grouped into ICD-9-CM codes as follows (morphology codes are from ICD-O-3):
200.0	Reticulosarcoma 95923, 95933, 95943, 96803, 96813, 96823, 96983	201.4	Lymphocytic-histiocytic predominance 96573, 96583, 96593
200.1	Lymphosarcoma 96703, 96733, 96853,	201.5	Nodular sclerosis 96633, 96643, 96653, 96663, 96673
200.2	Burkitt tumor or lymphoma 96873	201.6	Mixed cellularity 96523
200.8	Other named variants 95913, 96713, 96723, 96743, 96753, 96763, 96833, 96843, 96863, 96913, 96923, 96953, 96973	201.7	Lymphocyte depletion 96533, 96543, 96553
201.0	Hodgkin paragranuloma 96603	201.9	Hodgkin lymphoma, unspecified 96503
201.1	Hodgkin granuloma 96613	202.0	Nodular lymphoma 96903, 96933, 96943, 96963
201.2	Hodgkin sarcoma 96623	202.8	Other lymphomas 95903

All primary site codes except extranodal cases should be coded to C77._.

Equivalent terms for non-Hodgkin lymphomas:

follicular/nodular
lymphocytic/small (cell)
histiocytic/ large (cell)
mixed lymphocytic-histiocytic/mixed small and large cell
centroblastic/non-cleaved
centrocytic/cleaved
lymphoblastic/convoluted T-cell
Ki-1/CD30

Follicular lymphoma = follicle center cell lymphoma
Mantle cell lymphoma = mantle zone lymphoma
Anaplastic large B-cell lymphoma = diffuse large cell lymphoma
Mature T-cell lymphoma, NOS = peripheral T-cell lymphoma

Primary Site

Code the site of origin, not the site of biopsy.

If single lymph node chain (Stage I), code that site.

If more than one nodal area (Stage II-IV), code C77.8, lymph nodes of multiple regions.

For lymphomas, any mention of lymph nodes is indicative of involvement. Any reference to lymph nodes as enlarged, rubbery, "shotty," matted, or with visible swelling should be considered involvement by lymphoma. A reference to "rock hard" may mean involvement by carcinoma instead.

Lymphomas may originate from any lymphoid tissue in the body, including lymph nodes and lymphoid cells in other sites (extranodal sites).

When a lymphoma arises at an extranodal site and there is no lymph node involvement near that site, code the primary site to the organ of origin. For example, a primary lymphoma of the stomach is coded to the appropriate subsite in C16._ It is important to code the location of the lymphoma's origin, not the site of the biopsy.
If only lymph nodes are involved, determine which lymph node chain is the origin of the lymphoma. The lymph node chain that is biopsied is not necessarily the one where the lymphoma originated. (Cervical lymph nodes are easier to biopsy than mediastinal or retroperitoneal nodes.) Code the primary site to the lymph node chain where the lymphoma originated.

Involvement of a single organ such as stomach or bowel is Stage Ie, not Stage IV.

For bone lesions, determine whether there is a single lesion (possibly a primary in bone) or multiple lesions (probably metastases from another site).

If the origin cannot be determined and the lymphoma is believed to be nodal, code to C77.9, lymph node not otherwise specified. If the lymphoma is believed to be extranodal and the site of origin cannot be determined, code to C80.9, unknown primary site, unless another site is suggested in ICD-O-3.
Example: 9689/3 Splenic marginal zone B-cell lymphoma (C42.2)

Other Guidelines

All users of this module are encouraged to download and read the very useful
material contained in the "ABSTRACTING AND CODING GUIDE FOR THE HEMATOPOIETIC DISEASES" publication available here.

Size of primary tumor for lymphoma is not applicable; enter 999 in this field.

If there is no mention of extranodal involvement but several diagnostic procedures were done, including laparotomy, interpret as no involvement.

Involvement of soft tissue adjacent to lymph nodes does not alter the staging.

If Stage IV disease is documented by biopsy, no further staging workup is necessary.

If bilateral lymph node chains are involved, for example, bilateral inguinal nodes, consider them as two chains or regions for the purpose of assigning a stage.

The extent of the clinical evaluation must be guided by the type of therapy proposed. If aggressive therapy is planned, there should be extensive evaluation and careful staging of the case.

How to Tell Extranodal Disease from Stage IV

Site of origin
stomach, colon, brain, uterus--most likely extranodal
bone, lung--most likely Stage IV
liver, bone marrow--always Stage IV

Number of foci/lesions
one--extranodal
many or diffuse--Stage IV

WHO Classification terminology (Table 13 in ICD-O-3) is the preferred classification.

If two diagnoses are given, code the more specific term, which may not be the one with the higher code number. Terms considered non-specific
9590/3	Malignant lymphoma, NOS
9591/3	Non-Hodgkin lymphoma, NOS
9650/3	Hodgkin lymphoma, NOS
9680/3	ML, diffuse large B-cell, NOS
9690/3	Follicular lymphoma, NOS
9702/3	Mature T-cell lymphoma, NOS
9727/3	Precursor cell lymphoblastic lymphoma, NOS

For lymphomas, T- and B-cell information takes precedence over grading or differentiation. Code any statement of T-, NK- or B-cell involvement whether or not marker studies are documented, including the term phenotype. If the medical record does not indicate phenotype, DO NOT code from the header in ICD-O-3.

6th Digit Phenotype Codes

5 T-cell
6 B-cell
7 Null cell
8 NK cell
9 Not determined, not graded

Coding a Lymphoma Diagnosed in Bone Marrow Only

In the absence of more information
Site: C77.9 Lymph node, NOS
Histology: Lymphoma, NOS or more specific code
Stage IV (BM infiltrate)