Hairy cell leukemia

ICD10 Diagnosis
Dx:	Hairy cell leukemia
ICD10 code:	C91.4
Pre-ICD10 counterpart:	none assigned
Charlson/ALERT Scale:	Any malignancy, including lymphoma and leukemia, except of skin
APACHE Como Component:	Immunocompromised
APACHE Acute Component:	none
Start Date:
Stop Date:
External ICD10 Documentation	ICD-10 CM Wikipedia ICD-10 Wikipedia WHO ICD10 documentation ICD10data.com

This diagnosis is a part of ICD10 collection.

• SMW
  • 2019-01-01
  • 2999-12-31
  • C91.4

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Additional Info

• Hairy cell leukemia is a rare, slow-growing cancer of the blood in which the bone marrow makes too many B cells (lymphocytes), a type of white blood cell that fights infection. These excess B cells are abnormal and look "hairy" under a microscope.

Leukemia vs Lymphoma

Any lymphoma may have a leukemic phase where the abnormal clonal cells appear in the circulation. Though this is sometimes referred to as a "leukemia", even by some oncologists, that is technically incorrect and ICD10 considers them to be lymphomas. This applies to essentially ALL so-called B-cell leukemias, which are actually lymphomas. It also applies to "NK-cell leukemia" which is also a lymphoma

As such, the following so-called "leukemias" should be coded as follows:

• So-called B-cell leukemias describes several different types of lymphoid lymphomas which affect B cells -- and all these should be coded as Lymphoma, NOS
  • "B cell chronic lymphocytic leukemia"
  • "Precursor B cell lymphoblastic leukemia"
  • "Acute Lymphoblastic leukemia, mature B cell type"
  • "B cell prolymphocytic leukemia"

• So-called "NK-cell leukemia" -- code as T-cell lymphoma
  • Aggressive NK-cell leukemia (also called aggressive NK-cell lymphoma, or ANKL), is a very rare type of NHL. The body makes large numbers of NK cells that are larger than normal. It is grouped with T-cell lymphomas.
  • There is a very rare slow-growing (indolent) type of NK-cell leukemia that has a more favorable prognosis. It is called chronic NK-cell leukemia and is treated like T-cell large granular lymphocytic leukemia.
• The most common type of lymphoid leukemia is B-cell chronic lymphocytic leukemia.

Using ICD10 Malignancy Codes as a Comorbid Diagnosis

• Any cancer/malignancy (either a "solid tumor" or a leukemia/lymphoma/bone marrow malignancy/"liquid tumor", i.e. any ICD10 code from C00-C99) can be a comorbid diagnosis --- BUT it's vital to distinguish malignancies in this category based on whether they are believed to be cured or not.

• If it's still present (or believed to be present), then just include the code for the specific cancer as a comorbid diagnosis.
• If INSTEAD, it's presumed cured, then in the "bin" of comorbid diagnoses combine the code for the specific cancer with this code: Past history, cancer (any type), believed cured

C00-C99 codes codes:

ICD10_code description C14 Lip or mouth or tonsils or pharynx, primary malignancy C15 Esophagus, primary malignancy C16 Stomach, primary malignancy C17 Small intestine, primary malignancy C18 Colon (large intestine), primary malignancy C20 Rectum or anus, primary malignancy C22 Liver, primary malignancy C23 Gallbladder, primary malignancy C24 Biliary tract, primary malignancy C25 Pancreas, primary malignancy C26.1 Spleen, primary malignancy C26.9 GI organ NOS, primary malignancy C30 Nasal cavity or sinus or middle ear, primary malignancy C32 Larynx, primary malignancy C33 Trachea, primary malignancy C34 Lung and/or bronchus, primary malignancy C37 Thymus, primary malignancy C38.0 Heart, primary malignancy C38.3 Mediastinum, primary malignancy C38.4 Pleura, primary malignancy C39 Respiratory system NOS, primary malignancy C41 Bone or cartilage (any location), primary malignancy C43 Skin, malignant melanoma C44 Skin NOS, primary malignancy C45 Mesothelioma (any site) C46 Kaposi's sarcoma C47 Nerves, peripheral or autonomic, primary malignancy C48.1 Peritoneal tissue/peritoneum, primary malignancy C49 Connective or soft tissue NOS (external or internal), primary malignancy C50 Breast, primary malignancy C53 Cervix, primary malignancy C54 Uterus, primary malignancy C56 Ovary, primary malignancy C57 Female genitalia NOS (internal or external), primary malignancy C58 Placenta, primary malignancy C61 Prostate, primary malignancy C62 Testis (testicular), primary malignancy C63 Male genitalia NOS (internal or external), primary malignancy C64 Kidney, primary malignancy C66 Ureter, primary malignancy C67 Bladder, primary malignancy C68 Urinary organ NOS, primary malignancy C69 Eye, primary malignancy C70 Meninges, primary malignancy C71 Brain, primary malignancy C72.0 Spinal cord, primary malignancy C72.9 Central nervous system NOS, primary malignancy C73 Thyroid gland, primary malignancy C74 Adrenal gland, primary malignancy C75.0 Parathyroid gland, primary malignancy C75.1 Pituitary gland, primary malignancy C75.9 Endocrine gland NOS, primary malignancy C76.0 Head and neck and face, primary malignancy C76.8 Primary malignancy (solid tumor) of site unknown or NOS C77 Lymph nodes, metastatic malignancy to them (also code primary site) C78.0 Lung, metastatic malignancy to it (also code primary site) C78.2 Pleura, metastatic malignancy to it (also code primary site) C78.3 Respiratory system NOS, metastatic malignancy to it (also code primary site) C78.6 Peritoneum, metastatic malignancy to it (also code primary site) C78.7 Liver or biliary system, metastatic malignancy to it (also code primary site) C78.8 Gastrointestinal system NOS, metastatic malignancy to it (also code primary site) C79.0 Urinary system NOS, metastatic malignancy to it (also code primary site) C79.3 Brain or meninges, metastatic malignancy to it (also code primary site) C79.5 Bone or bone marrow, metastatic malignancy to it (also code primary site) C79.7 Adrenal gland, metastatic malignancy to it (also code primary site) C79.9 Site NOS, metastatic malignancy to it (also code primary site) C7A.0 Malignant carcinoid tumor C81 Hodgkin's lymphoma (Hodgkin's disease) C84 T-cell lymphoma C85.7 Non-Hodgkin's lymphoma C85.8 Lymphoma, NOS C88 Malignant immunoproliferative disease C90.0 Multiple myeloma C90.1 Plasma cell leukemia C90.21 Plasmacytoma, NOS C91.0 Acute lymphoblastic leukemia (ALL) C91.1 Chronic lymphocytic leukemia (CLL) C91.3 Prolymphocytic leukemia C91.4 Hairy cell leukemia C91.5 T-cell leukemia C91.7 Lymphoid leukemia, NOS C92.0 Acute myeloid leukemia (AML) C92.1 Chronic myeloid leukemia (CML) C92.4 Acute promyelocytic leukaemia (APL) C92.5 Acute myelomonocytic leukaemia (AMML) C93 Monocytic leukemia, acute or chronic C94.0 Acute erythroblastic leukemia (erythroleukemia) C94.2 Acute megakaryoblastic leukemia C95.0 Leukemia, NOS C96 Malignancy (clonal disorder) of blood or lymphoid tissue, NOS

Metastases

Regarding Presumptive Diagnosis of Malignancy

• Rarely a presumptive diagnosis is made without any tissue confirmation. This generally occurs with:
  1. risk of obtaining tissue is very high
  2. plan would be palliative regardless
  3. patient would refuse care regardless.
• Our issue for how to code a presumed malignancy without definitive histopathologic proof is this:
  • If the physicians are going to proceed with a treatment plan without that definitive histopathologic proof --- then code whatever is their best guess about what is present. Example: believed to be lung cancer with a big brain met, and they've decided NOT to do any biopsy but to give palliative radiation therapy, then you'd code lung cancer, and met to brain.
  • If the plan is to obtain a definitive histopathologic diagnosis soon or in the future, then instead code: Neoplasm of uncertain behavior (i.e. not clear if benign or malignant), NOS

"work-up for cancer"

If the cancer has not been confirmed then it should not be coded as cancer. Code relevant test abnormal test results or symptoms.

Example:

"I have a patient who comes in with vague respiratory and gi symptoms. They did a chest xray and found a lung mass. They are now working him up for a probable lung ca, with mets to various places. In the old coding I would use ca-nyd. I actually use the ca nyd subcode a lot. I’ve talked to you about this before, because there is no ca nyd in icd10. You told me that you either have cancer or you don’t. For this particular patient I really wouldn’t have anything else I could code in icd10 for him. His symptoms are extremely vague. I don’t really like coding just symptoms, if there isn’t a proper admit diagnosis that fits better anyway. I found a “neoplasm of uncertain behavior (i.e. uncertain if benign or malignant), nos”, but I don’t really like that one. It doesn’t really fit. Is it possible to get something like “admit for workup of malignancy”, or something along those lines?" (Debbie, 12:40, 2018 October 4 (CDT)) How should this be coded? Ttenbergen 12:40, 2018 October 4 (CDT)

Alternate ICD10s to consider coding instead or in addition

Candidate Combined ICD10 codes

• Chronic lymphocytic leukemia (CLL)

Related CCI Codes

Data Integrity Checks (automatic list)

none found

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