Wiki remission coding while still under therapy

[LOUISE SLACK]

Hello group,

When coding leukemia and the medical record says in remission but the patient is still having chemotherapy which do we code, the in remission code or not having achieved remission.

ICD10 guidelines say to report the malignancy for which therapy/treatment is needed until the patient is no longer receiving any treatment or therapy then code "history of". But with the C90 category of codes there is the option of not having achieved remission, in remission or in relapse.

I have found that a providers clinical diagnosis and ICD-10 do not always have the same definition.

My providers do not consider a patient cured of a malignancy until after 5 years out from treatment but ICD says to code history of as soon as treatment is over.

From an ICD 10 standpoint would we code remission or since still receiving treatment code not having achieved remission. In other words does ICD-10 consider remission as no evidence of disease or go by the definition of remission indicating disease is improving yet still present.
Thank you,
Louise

 

[ChattRiskCoder]

Leukemia is systemic and can go through periods of remission and relapse. It may or may not require active treatment. Patients who are in remission are still considered to have the disease and should be coded as active.
I believe there is a Coding Clinic that addresses this. CC, Second QTR 1992 page 3.

 

[trarut]

Louise,

I was taught that the provider must state the patient is in remission or relapse before those codes can be assigned and to never code leukemia or lymphoma to history because it's always there, even if it isn't active at the moment.

 

[Journeygirl712]

After 2 years at a Hematology / Oncology Clinic..... I was always taught that as long as there is active treatment / therapy / chemo / meds etc. it is acceptable to consider the condition "active" though the provider has called the condition a history of in their notes. I had 2 providers that I think meant for this statement to reflect that "it's been going on for a while" more than they intended for it to say "they used to have".
As long as you have a Medication Admin Summary or something to that effect you should A-ok to call it active and I agree with Louise. Lymphoma & Leukemia should never be a "history of".
Which begs the question...... why are the codes there?

 

[trarut]

After 2 years at a Hematology / Oncology Clinic..... I was always taught that as long as there is active treatment / therapy / chemo / meds etc. it is acceptable to consider the condition "active" though the provider has called the condition a history of in their notes. I had 2 providers that I think meant for this statement to reflect that "it's been going on for a while" more than they intended for it to say "they used to have".
As long as you have a Medication Admin Summary or something to that effect you should A-ok to call it active and I agree with Louise. Lymphoma & Leukemia should never be a "history of".
Which begs the question...... why are the codes there?

The bolded above is what I was taught as well. I've never understood the logic of the leukemia/lymphoma history codes either...and it's not like they're new to ICD-10. They were in ICD-9 too and with more specificity