Is C26.1 a billable ICD-10-CM code?

Yes. C26.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does C26.1 sit in the tabular list?

Neoplasms (C00-D49), in the block Malignant neoplasms of digestive organs (C15-C26).

What cannot be coded together with C26.1?

C26.1 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

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.

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)

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.

Medicare coverage

C26.1 is named in 47 Medicare coverage policies — 47 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

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

Related codes at this level

Codes that share C26. If C26.1 is not quite right, the correct code is usually one of these.

Questions about C26.1

Is C26.1 a billable ICD-10-CM code?: Yes. C26.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does C26.1 sit in the tabular list?: Neoplasms (C00-D49), in the block Malignant neoplasms of digestive organs (C15-C26).
What cannot be coded together with C26.1?: C26.1 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.