Oncology & Hematology Coding Alert

Question: What is the appropriate ICD-9-CM code for “acute lymphoblastic leukemia (ALL) with central nervous system (CNS) relapse?” Does the CNS relapse indicate that the leukemia is in relapse? Would you code this to 204.02 or 204.00?.

Florida Subscriber

Answer: You consider the CNS relapse as ALL in relapse and report code 204.02 (Acute lymphoid leukemia, in relapse). Since your physician has clearly documented that the patient is seen in a relapse, code 204.00 (Acute lymphoid leukemia, without mention of having achieved remission) is not appropriate. You report 204.00 when your physician does not clearly mention that the patient ever attained a remission.

Relapse in ALL: Relapse in leukemia is essentially an outgrowth of a clonal cell population (group of cells derived from a common parent cell and sharing a genetic identity), that has not been not completely eliminated by treatment. Relapse in ALL can be medullary (i.e., involving the bone marrow) or extramedullary. The two can also co-exist. According to the National Cancer Institute, patients who have isolated extramedullary relapse fare better than those who have relapse involving the marrow. The major sites of extramedullary relapse are the CNS and testes. CNS relapse appears to be a common area of concern for ALL patients. Though uncommon, relapse involving other extramedullary sites may also occur.

ICD-10: When your diagnosis system changes, you’ll look to C91.02 (Acute lymphoblastic leukemia, in relapse) instead of 204.02. For 204.00, you would shift to C91.00 (Acute lymphoblastic leukemia, not having achieved remission).