Pathology/Lab Coding Alert

You’ll need more diagnostic information for HPC transplant patients.

"Acute myeloid leukemia" (AML) and remission status isn’t all you’ll need to know for diagnosis coding once ICD-9 is gone. That’s because ICD-10, which goes into effect Oct. 1, 2014, provides far more granularity for reporting this common leukemia diagnosis.

Old way: 205.0x Shows Just One AML

For now, all transplant or post-transplant cellular infusions your pathologist/hematologist performs for AML patients reports to diagnosis code 205.0x (Acute myeloid leukemia).

The fifth digit reports remission status, as follows:

0 — without mention of having achieved remission (includes failed remission)

1 — in remission

2 — in relapse.

New way: C92.-- Gives Greater Detail

Once your practice starts reporting ICD-10, you’ll need to know far more about the patient’s diagnosis due to greater fourth-digit specificity, as follows:

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 each of the preceding codes, ICD-10 provides a fifth digit to indicate remission status as follows, similar to ICD-9:

0 — not having achieved remission

1 — in remission

2 — in relapse.

Documentation: Because your ICD-10 code choices for AML will be much more specific than your current ICD-9 options, you need to work with clinicians to ensure that documentation is adequate for the new code set. For instance, you’ll need to know whether the patient has "11q23-abnormality," or "multilineage dysplasia," if you want to select the proper diagnosis code.

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, you should report AML M3 as C92.4- and AML M4 as C92.5-, according to the inclusion notes.

Remember: Once you begin using ICD-10, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/Medicare/Coding/ICD10.