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Diagnosis code 205.00 versus 205.01 ?

Donna m Posted Thu 09th of January, 2014 17:05:50 PM

When a patient has maintenance chemotherapy to KEEP them in remission should we be using the (Leukemia) remission DX 205.01?
Or since they are only in remission because of the maintenance chemotherapy treatment should we consider the patient as NOT in remission and use 205.00?

Thank you.

SuperCoder Answered Fri 10th of January, 2014 19:34:28 PM

Per the ICD9 AHA Coding Clinic the following applies to chemo given for Leukemia:

Patients with acute leukemia (acute lymphocytic leukemia [ALL] or acute myelogenous leukemia [AML]) receive chemotherapy at various times throughout the course of the disease process. Dosage and drug protocol is individualized based upon patient condition, diagnosis, and geographic location, as well as physician preference and training. Individual protocols fall into the following basic types.

Remission induction chemotherapy is given first, in order to reduce the leukemia cell mass and induce remission. A 7-day course of chemotherapy is given. If remission is induced, the effect may last several weeks. If remission is not induced, several additional courses of chemotherapy may be given in order to induce remission.

Consolidation (a.k.a. early intensification) chemotherapy is given immediately following the achievement of the remission status. This is a time of intensive chemotherapy administration, with the chemotherapy drugs given at the same or higher dosage than during the remission induction phase. Only one course may be required, or 2-4 courses may be required.

Maintenance chemotherapy is given after consolidation therapy is completed, and is usually continued over several years. This is at a lower dose than the consolidation mode and is usually given on an outpatient basis.

Late intensification chemotherapy may be administered as- an intensive chemotherapy phase (depending upon the physician's theory of treatment), and is given as a reinforcement ("for good measure") to a patient who still is in remission. It can be given to the patient more than 6 months after the remission induction.

If a patient relapses during any of the above treatment phases, a re-induction may be attempted to reinduce remission.

In 2005, the AHA Coding Clinic published answers on how to code for these types of chemo based on the addition of code V58.11

For resmission induction, consolidation, maintenance and re-induction chemo for leukemia, the primary Dx is V58.11 and the secondary is the acute leukemia code without remission.

For late intensification chemo, the primary Dx is V58.11 and the secondary is acute leukemia with remission. so you need to know which was the case in order to code correctly.

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