2025 ICD-10-CM code C96
(Active) Effective Date: N/A Neoplasms - Malignant neoplasms of lymphoid, hematopoietic and related tissue (C81-C96) 2 Feed
Malignant neoplasms of lymphoid, hematopoietic and related tissue, unspecified.
Medical necessity for C96 relies on documentation of clinical findings suggestive of a malignant neoplasm, such as abnormal blood counts, enlarged lymph nodes, or other symptoms. The lack of specificity necessitates the use of C96 until a more precise diagnosis can be established.
Diagnosis of these conditions involves physical examination, blood tests (CBC, peripheral smear, blood chemistries, specific enzyme levels), bone marrow biopsy or fine needle aspiration, microscopic and cytologic analysis, genetic analysis, and imaging studies (CT, MRI, PET, ultrasound). Treatment depends on the specific type of tumor, disease stage, and patient age, and often includes chemotherapy, sometimes in combination with steroids.
In simple words: This code refers to a cancerous condition affecting the blood, bone marrow, lymph, and lymphatic system, specifically when the exact type is not specified.
Other and unspecified malignant neoplasms of lymphoid, hematopoietic and related tissue. This code encompasses malignant neoplasms that are not otherwise specified within the C81-C96 range.
Example 1: A patient presents with fatigue, weight loss, and enlarged lymph nodes. After undergoing a biopsy, the pathology report indicates a malignant neoplasm of lymphoid tissue, but the specific type is not identified. C96 is used until further testing can specify subtype., A patient with a history of leukemia experiences a relapse with unspecified characteristics. C96 is applied to document recurrence., A patient presents with symptoms suggestive of a hematological malignancy, but initial diagnostic tests are inconclusive regarding type. C96 serves as a placeholder.
Documentation should include complete blood count (CBC) results, imaging reports, biopsy/pathology findings, and a detailed description of the patient's clinical presentation. As always, ensure all documentation clearly supports medical necessity.
** Excludes1: personal history of other malignant neoplasms of lymphoid, hematopoietic and related tissues (Z85.79). Excludes2: Kaposi's sarcoma of lymph nodes (C46.3), secondary and unspecified neoplasm of lymph nodes (C77.-), secondary neoplasm of bone marrow (C79.52), secondary neoplasm of spleen (C78.89).
- Specialties:Hematology, Oncology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office, Independent Clinic