Keep these coding tips in mind to improve medical record documentation

Leukemia is cancer of the white blood cells that will affect an estimated 44,790 new patients in 2014 alone, according to Medscape. A basic understanding of this neoplastic disorder will help with coding and documentation accuracy. The body is constantly producing new blood cells to stay healthy. Blood cells are produced by blood stem cells found within bone marrow and occasionally the blood itself.

Blood stem cells produce three specific types of blood cells: red blood cells, platelets and white blood cells. Each blood cell has a unique function within the body, aiding in healing and healthy living. When normal blood cells are old or damaged they die off and new ones are produced.

Graphic taken from National Cancer Institute website/2014

Blood cell functions Red blood cells: Oxygen transporters Platelets: Clot formers, slow or stop bleeding White blood cells: Infection fighters

Leukemia occurs when the bone marrow starts producing abnormal white blood cells known as leukemia cells or leukemia blast cells. The production of the abnormal white blood cells takes over cell production, causing normal blood cell production to be halted. Leukemia cells multiply quickly and don’t die off like normal blood cells. Without the production of normal blood cells the body works harder to get oxygen, control bleeding and fight infections.

Leukemia is divided into two types based on origin: myeloid or lymphoid. The two types are further classified based on an acute or chronic designation.

• Acute myeloid leukemia
• Acute lymphoblastic leukemia
• Chronic myeloid leukemia
• Chronic lymphocytic leukemia

Understanding the differences between acute and chronic leukemia is important. Within ICD-9-CM, leukemia is broken down into acute, chronic and sub-acute designations. Acute leukemia is when the bone marrow cells fail to mature properly and the outcome is poor if left untreated. But with the right treatment most cases can be cured.

Chronic leukemia differs slightly. The bone marrow cells mature some but not entirely and might look OK under examination, yet are unable to fight off infections. The outcome on life is longer however, chronic leukemia is much harder to cure. ICD-9-CM also contains a sub-acute designation, which is identified as a state between acute and chronic, leaning more towards acute, yet usually less severe than acute.

Tips to remember when coding leukemia
Leukemia codes are found throughout the neoplasm chapter and specific types are categorized in sections 204 through 208.

• Physicians must clearly document the specific type of leukemia and whether it is acute, chronic or, in some cases, sub-acute.
• Chronic leukemia may enter a blast phase meaning the symptoms or manifestations are close to that of an acute leukemia. The tabular contains an EXCLUDES note that indicates "acute exacerbations of chronic leukemia." Do not report both an acute and chronic code — unlike other conditions, only the chronic code is reported.
• Relapse refers to the recurrence of the disease after being successfully treated. A relapse can occur at any time during treatment or after treatment is completed. The provider must clearly document the patient is "in remission" or "in relapse" so the appropriate fifth digit may be assigned.
• 0 — Without mention of having achieved remission (includes failed remission): According to American Hospital Association Coding Clinic fourth quarter, 2008, page 83 through 84, failed remission refers to remission induction therapy where the patient is given a course of chemotherapy to produce a complete remission and the treatment fails.
• 1 — In remission: Currently not showing any signs or symptoms of the disease.
• 2 — In relapse: Signs and symptoms of the disease have reoccurred after being treated successfully.
• If the reason for a patient encounter is chemotherapy, report V58.11 or V58.12 as the primary diagnosis code (encounter for antineoplastic chemotherapy/immunotherapy) followed by the correct leukemia code.
• Leukemia is classified in the neoplasm chapter, yet it’s not found within the neoplasm table. In order to accurately code leukemia it must first be located in the alphabetical list, under the correct subcategory. Code verification in the tabular is essential for accurate fifth-digit reporting.

If you have questions or need more information, please contact your provider consultant.