Malignancy (clonal disorder) of blood or lymphoid tissue, NOS
|Dx:||Malignancy (clonal disorder) of blood or lymphoid tissue, NOS|
|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|
|External ICD10 Documentation|
- Clonal disorders of blood or lymphoid tissue include the myeloproliferative disorders, leukaemias and lymphomas, all of which are conditions where a single blood / bone marrow cell begins to multiply abnormally, giving rise to a large number of cells (i.e. a clonal blood disorder).
- Langerhans cell histiocytosis (LCH) - a rare disease involving clonal proliferation of Langerhans cells, abnormal cells deriving from bone marrow and capable of migrating from skin to lymph nodes. Clinically, its manifestations range from isolated bone lesions to multi-system disease.
- Eosinophilic granuloma, also known as pulmonary histiocytosis X (PHX) or pulmonary Langerhans cell histiocytosis X (PLCH) - is an uncommon interstitial lung disease that is epidemiologically related to tobacco smoking
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
Regarding Presumptive Diagnosis of Malignancy
- Rarely a presumptive diagnosis is made without any tissue confirmation. This generally occurs with:
- risk of obtaining tissue is very high
- plan would be palliative regardless
- 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.
"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
- Myeloproliferative diseases
- Myelodysplastic syndrome/myelodysplasia (preleukemia, refractory anemia)
- Hodgkin's lymphoma (Hodgkin's disease)
- Non-Hodgkin's lymphoma
- T-cell lymphoma
- Lymphoma, NOS
Candidate Combined ICD10 codes
Related CCI Codes
Data Integrity Checks (SMW)