Resolved Coding T cell non hodgkins lymphoma with positive CD30

[MonicaA_91809]

Pt with T cell non hodgkins lymphoma with positive CD30. ALK negative. Stage II with involvement of scalp and both sides of the neck lymph nodes. ongoing chemotherapy.

What would be the correct code for the lymphoma?
Does a Positive CD30 mean it is a anaplastic large cell lymphoma?
Per my lead the correct code is C84.78 but I dont see how it is anaplastic large cell if it is not documented anywhere in the chart.

 

[Alicia]

To address your questions, let's break down the information:

1. Correct Code for the Lymphoma:
   
   • The patient has T-cell non-Hodgkin's lymphoma with CD30 positivity and ALK negativity, involving the scalp and lymph nodes on both sides of the neck. This suggests a diagnosis of Anaplastic Large Cell Lymphoma (ALCL), ALK-negative.
   • The ICD-10 code for ALK-negative ALCL is C84.7. However, since the lymphoma involves lymph nodes of multiple sites, the more specific code would be C84.78 (Anaplastic large cell lymphoma, ALK-negative, lymph nodes of multiple sites) if it is confirmed to be ALCL.
2. Positive CD30 and Anaplastic Large Cell Lymphoma:
   
   • A positive CD30 result is a hallmark of Anaplastic Large Cell Lymphoma (ALCL), but it is not exclusive to ALCL. CD30 positivity is also seen in other lymphomas, such as Hodgkin lymphoma and some types of cutaneous T-cell lymphomas56.
   • For a diagnosis of ALCL, the presence of CD30 positivity along with characteristic morphological features (e.g., hallmark cells) is crucial. If the chart does not explicitly mention ALCL or these features, it might be necessary to review the pathology report or consult with the pathologist to confirm the diagnosis.
3. Clarification Needed:
   
   • If the chart does not explicitly document ALCL, using C84.78 might not be accurate without further confirmation. You should verify the diagnosis with the healthcare provider or pathologist to ensure accurate coding.

In summary, while CD30 positivity is a strong indicator of ALCL, confirmation of the specific type of lymphoma (in this case, ALK-negative ALCL) requires documentation of characteristic morphological features or explicit mention in the medical record. If confirmed as ALCL, C84.78 could be appropriate, but otherwise, a more general T-cell lymphoma code might be needed until the diagnosis is clarified.

Here are some helpful sites:

CD30(+) anaplastic large cell lymphoma: a review of its histopathologic, genetic, and clinical features - PubMed

Anaplastic large cell lymphoma (ALCL) represents a generally recognized group of large cell lymphomas. Defining features consist of a proliferation of predominantly large lymphoid cells with strong expression of the cytokine receptor CD30 and a characteristic growth pattern. With the use of...

pubmed.ncbi.nlm.nih.gov

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