2027 ICD-10-CM Diagnosis Code C86.40Blastic NK-cell lymphoma not having achieved remission
ICD-10-CM Codes›C00–D49›C81-C96›C86
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 19
- Chronic Condition
C86.40 is a billable ICD-10-CM diagnosis code for blastic NK-cell lymphoma not having achieved remission. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 820 through 825, 840 through 842, 974 through 976. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 151 closely related codes. Coders also document this condition as blastic plasmacytoid dendritic cell neoplasm. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Non-Hodgkin lymphoma.
For Medicare Advantage risk adjustment, C86.40 maps to CMS-HCC Category 19 (Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers) under the V28 model, adding a risk factor of about 1.798 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
C86.40 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Blastic plasmacytoid dendritic cell neoplasm
- NK-lymphoblastic leukemia/lymphoma
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to C86.40: its own notes plus those printed at C86, block C81-C96, and Chapter 2. A note printed at a category, block or chapter applies to every code under it.
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Blastic NK-cell lymphoma NOS
- Blastic NK-cell lymphoma with failed remission
- Blastic plasmacytoid dendritic cell neoplasm (BPDCN) NOS
- Blastic plasmacytoid dendritic cell neoplasm (BPDCN) not having achieved remission
- Blastic plasmacytoid dendritic cell neoplasm (BPDCN) with failed remission
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
Notes
General instructions on how these codes are used.
- Functional activity
- All neoplasms are classified in this chapter, whether they are functionally active or not. An additional code from Chapter 4 may be used, to identify functional activity associated with any neoplasm.
- Morphology [Histology]
- Chapter 2 classifies neoplasms primarily by site (topography), with broad groupings for behavior, malignant, in situ, benign, etc. The Table of Neoplasms should be used to identify the correct topography code. In a few cases, such as for malignant melanoma and certain neuroendocrine tumors, the morphology (histologic type) is included in the category and codes.
- Primary malignant neoplasms overlapping site boundaries
- A primary malignant neoplasm that overlaps two or more contiguous (next to each other) sites should be classified to the subcategory/code .8 ('overlapping lesion'), unless the combination is specifically indexed elsewhere. For multiple neoplasms of the same site that are not contiguous, such as tumors in different quadrants of the same breast, codes for each site should be assigned.
- Malignant neoplasm of ectopic tissue
- Malignant neoplasms of ectopic tissue are to be coded to the site mentioned, e.g., ectopic pancreatic malignant neoplasms are coded to pancreas, unspecified (C25.9).
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name C86.40, its category, or a range that includes it.
Excludes1 2
These codes carry an Excludes1 note naming C86.40: they are not reported together with it, unless the two conditions are unrelated.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Blastic Plasmacytoid Dendritic Cell Neoplasm
a rare and aggressive hematologic malignancy derived from the precursors of plasmacytoid dendritic cells. blastic plasmacytoid dendritic cell neoplasms affect bone marrow and blood in addition to the lymph nodes, spleen, central nervous system, and skin.
Patient EducationClinical
Lymphoma
Lymphoma is a cancer of a part of the immune system called the lymph system. There are many types of lymphoma. One type is Hodgkin disease. The rest are called non-Hodgkin lymphomas.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Code History & ChangesHistory
Replacement C86.40 replaces the following previously assigned code(s):
- C86.4 - Blastic NK-cell lymphoma
Questions About C86.40Overview
What is the ICD-10 code for blastic NK-cell lymphoma not having achieved remission?
The ICD-10-CM code for blastic NK-cell lymphoma not having achieved remission is C86.40 (sometimes written as C8640). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is C86.40 (Blastic NK-cell lymphoma) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report blastic NK-cell lymphoma not having achieved remission on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does C86.40 group to?
When blastic NK-cell lymphoma not having achieved remission is the principal diagnosis on an inpatient stay, it groups to MS-DRG 820, 821, 822, 823, 824, 825, 840, 841, 842, 974, 975, 976, with relative weights from 0.7879 to 6.2454 depending on complications. Higher weights mean higher Medicare reimbursement.
Is C86.40 a CC or MCC?
CMS lists C86.40 as a CC (complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 151 closely related codes in its exclusion list.
Can C86.40 be reported with a code from C84.7?
Not as a rule. The Excludes1 note at C86, which applies to C86.40, lists "anaplastic large cell lymphoma, ALK negative (C84.7-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What HCC is C86.40?
C86.40 (blastic NK-cell lymphoma not having achieved remission) maps to CMS-HCC Category 19 (Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers), commonly written as HCC 19, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 10 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 21.
Does C86.40 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, C86.40 adds a risk adjustment factor of about 1.798 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.957 to 1.989 depending on the payment segment). A more severe related category (HCC 17 and HCC 18) supersedes it when both are reported. See the full factor table on the HCC 19 category page.
