Oncology & Hematology Coding Alert

Question: Some oncology diagnosis codes for 2009 include changes to the fifth-digit classifications of no mention of remission, relapse, and remission. What are the differences?

Nebraska Subscriber

Answer: This fifth-digit change primarily applies to lymphatic neoplasms (and leukemias). The American Academy of Pediatrics (AAP) proposed the new sub-classifications to allow a separate classification for lymphatic neoplasms in relapse and to further distinguish the fifth-digit choices from one another.

The change: Previous editions of ICD-9 listed two choices for a fifth-digit classification among lymphatic neoplasms: 0 (without mention of remission) and 1 (in remission). ICD-9 2009 modifies and expands the classifications: 0 (without mention of having achieved remission [failed remission]), 1 (in remission), and 2 (in relapse).

Call on "0": Use the fifth digit of "0" when you are treating the primary disease not in remission; when you are treating the initial phase of the disease (the initial or first treatment); or when your physician does not state the status of the patient's disease or condition (you don't know the phase of treatment or the physician doesn't document that the patient is in remission or relapse).

Remission or relapse: With the new sub-classification of "relapse," ensure that you have a clear understanding of the term. If a patient is in remission, he has no active sign of disease and you would report the fifth digit "1." If the documentation states that the patient is in relapse, that means he has recurrent disease following previous treatment; and you-ll report the fifth digit "2."