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Thread: Can 198.5 be used with 203.00

  1. #1

    Question Can 198.5 be used with 203.00

    AAPC: Back to School
    My coworker is telling me that with the lymphoma codes the mets codes can not be used i have a patient with multiple myeloma with bone mets can I code the bone mets?

  2. #2


    From Coding Clinic, Second Quarter 1992 Page: 3

    Lymphomas are systemic diseases that do not "metastasize" in the same way that solid tumors do (classified to categories 140--199). A lymphoma, regardless of the number of sites involved, is not considered metastatic, and should be coded to the 200--202 categories. Solid tumors frequently metastasize to the lymph nodes and/or bone marrow. These are not lymphomas; they are secondary sites of the solid tumor. In cases of solid tumor metastases to the lymphatic system, a code from category 196, Secondary and unspecified malignant neoplasm of lymph nodes; code 197.8, Secondary and unspecified malignant neoplasm of spleen; or code 198.5, Secondary and unspecified malignant neoplasm of bone marrow, should be used. Lymphomas are specifically excluded from these categories. Codes 197.8 and 198.5 and codes from category 196 should never be used for lymphomas.

    Lymphoma is a general term for growth of new tissue in the lymphatic system. The lymphatic system consists of all structures involved in the conveyance of lymph from the tissues to the bloodstream. It includes the lymph capillaries, lacteals, lymph nodes, lymph vessels, and main lymphatic ducts (thoracic and right lymphatic duct). It also includes the lymphatic organs: the bone marrow, spleen, tonsils, and thymus gland. These organs are involved in the storage and/or production of lymphocytes (types of white blood cells without cytoplasmic granules). Lymphomas do not have to originate in the lymph glands. Thus, lymphomas may originate in any lymphoid tissue throughout the body and may not necessarily be restricted to lymph nodes or glands. The fifth digit of "0" is assigned for lymphomas in extranodal sites, such as bone.

    Lymphomas may be of several different types: reticulosarcoma (histiocytes), lymphosarcoma (lymphocytes or lymphoblasts), Burkitt's lymphoma, plasma cell lymphoma, mixed (lymphocytes and monocytes), and Hodgkin's disease.

    Lymphomas are classified in categories 200--202, depending upon the type of the lymphoma, with a fifth digit subclassification for the site(s) involved. If lymph nodes in more than one region of the body (e.g., head and thorax, neck and abdomen, axilla and lower limb, upper limb and pelvis) are involved, the fifth digit "8" should be assigned. Lymphoma patients who are in remission are still considered to have lymphoma and should be assigned the appropriate code from categories 200--202.
    Julianne Sheetz, CPC

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