Oncology & Hematology Coding Alert

Question: I have documentation showing the diagnosis CLL. What does this stand for and which codes apply to this diagnosis?

Wyoming Subscriber

Answer: First things first. If the record uses only abbreviations and does not spell out the actual diagnosis, ask the physician to amend the record. Abbreviations can be risky because they may have different meanings to different people. That could lead you to report the wrong code, convince an auditor to take a closer look at your records, and even affect patient care.

You should confirm the diagnosis with the physician, but chances are CLL refers to chronic lymphocytic leukemia, also called chronic lymphoid leukemia. CLL presents mostly in the blood and bone marrow.

The code range you should check for CLL is 204.1x (Lymphoid leukemia; chronic). Choose the fifth digit based on the patient's documented status:

0 -- without mention of having achieved remission, failed remission

1 -- in remission

2 -- in relapse.

Tip: You should report an acute exacerbation of CLL as 204.1x, as well. You should not report it using 204.0x (Lymphoid leukemia; acute).