Oncology & Hematology Coding Alert

Get a grasp on the extra documentation you'll need for AML coding.

Additional required details -- that's one of the main worries about converting to ICD-10 in 2013. Acute myeloid leukemia (AML) coding is no exception, but you can ease your worries by getting an early start on preparing for the transition.

The diagnosis: AML is one of the most common types of leukemia. It affects the bone marrow and the blood, particularly cells that haven't developed fully.

ICD-9-CM: Under ICD-9 you choose an AML code from 205.0x (Myeloid leukemia; acute). Your fifth digit depends on the disease's documented status:

• 0, without mention of having achieved remission (includes failed remission)
• 1, in remission
• 2, in relapse.

ICD-10-CM: ICD-10 2011 includes AML options in C92.- (Myeloid leukemia). Ranges specific to "acute" diagnoses include:

• C92.0-, Acute myeloblastic leukemia
• C92.4-, Acute promyelocytic leukemia
• C92.5-, Acute myelomonocytic leukemia
• C92.6-, Acute myeloid leukemia with 11q23-abnormality
• C92.A-, Acute myeloid leukemia with multilineage dysplasia

For all of the above ranges, your fifth digit will convey information similar to that of the ICD-9 fifth digits:

• 0, not having achieved remission
• 1, in remission
• 2, in relapse.

Documentation: Your ICD-10 options will be much more specific than your current ICD-9 options. If your documentation isn't currently set up in a way to allow you to quickly and accurately see that the oncologist diagnosed "11q23-abnormality" (C92.6-) or "multilineage dysplasia" (C92. A-), for example, work with your clinicians to be sure documentation is adequate and allows for efficient coding.

Coding tip: Take the time to review the inclusion notes with the various C92.- codes. You'll learn important rules for correct coding. For example, under codes with the fifth digit "0," you'll see the digit is appropriate if documentation doesn't mention remission or relapse. You'll also get important clues about which diagnoses fall under these new, more specific codes. For instance, AML M3 will be coded to C92.4- and AML M4 will be coded to C92.5-.

Remember: When ICD-10 goes into effect on Oct. 1, 2013, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.