Oncology & Hematology Coding Alert

Question: For acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL) and multiple myeloma, when would you consider the patient past remission and use the history of codes rather than the remission codes?

AAPC Forum Participant

Answer: There are two ICD-10-CM guidelines that help provide the answer to this question. The first, C.21.c.4, tells you that “personal history codes explain a patient’s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring.” From this, you may be tempted to apply a history code based on whether your provider or an outside provider is no longer providing treatment for the condition.

The reality is that you cannot assign a code this way. Instead, for the conditions you mention, ICD-10-CM Guideline C.2.n. tells you that “the categories for leukemia, and category C90, Multiple myeloma and malignant plasma cell neoplasms, have codes indicating whether or not the leukemia has achieved remission.”

So, if the patient is in remission for any of these conditions, you will use the appropriate codes:

• C90.01 (Multiple myeloma in remission)
• C91.01 (Acute lymphoblastic leukemia, in remission)
• C91.11 (Chronic lymphocytic leukemia of B-cell type in remission)

The guideline goes on to tell you that you can also choose personal history codes for the leukemia conditions, using Z85.6 (Personal history of leukemia), and Z85.79 (Personal history of other malignant neoplasms of lymphoid, hematopoietic and related tissues) for a history of ALL and CLL.

However, in the absence of an ICD-10-CM guideline telling you when to apply any of these codes, and in the absence of formal medical definitions that you can apply to conditions when they are in remission or have the status of personal history, Guideline C.2.n. only tells you that “the provider should be queried ... if the documentation is unclear as to whether the leukemia has achieved remission.”

Simply put, code choice in this situation is entirely based on the information provided within the provider documentation.