C26.1

C26.1: Malignant neoplasm of spleen

Billable / specific codeICD-10-CM

C26.1 is a billable, specific ICD-10-CM code for malignant neoplasm of spleen. It is valid for submission on a claim.

Check C26.1 with the rest of the claim: free scrubber

Excludes1: never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

Hodgkin lymphoma (C81.-)
non-Hodgkin lymphoma (C82-C85)

Excludes1 inherited from the categories above C26.1

A category’s note binds every code beneath it.

Written on C26: Malignant neoplasm of other and ill-defined digestive organs

malignant neoplasm of peritoneum and retroperitoneum (C48.-)

Risk adjustment

C26.1 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 22 Bladder, Colorectal, and Other Cancers0.363 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

C26.1 is named in 49 Medicare coverage policies: 49 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52479Oral Anticancer Drugs - Policy Article
A52480Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article
A54768Billing and Coding: Cardiac Blood Pool Imaging (Multiple Gated Acquisition Scanning- MUGA, Ventriculography) When Performed in Conjunction with Cardiotoxic Chemotherapy
A55717Billing and Coding: Lab: Flow Cytometry

Code history

Unchanged in every release from FY2024 to FY2027.