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Question: 20130028 Status

Source 1:   2012 Heme & Lymph Manual & DB
Source 2:  

Primary site--CLL/SLL: Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) diagnosed by axillary biopsy, peripheral Blood(+), no bone marrow biopsy. Patient has multiple LN involvement above and below diaphragm per CT

1. How do you know to go to Rule PH8 when looking in the Hematopoietic database and to abstract as C421 when primary site box says to go to Module 7?

2. What is primary site based on the above info?

3. Which bullet from PH8 do you follow and why?

1st bullet says that when only peripheral blood is involved (LN's may be involved) This is contradicting Note 3. 2nd bullet says code primary site to involved LNís when no bone marrow involvement or it is unknown (this is also contradicting to 1st bullet.

4. MD staged as Stage 0 with diagnosis CLL/SLL which is not the option when coded to LNís. Would I still code to lymph nodes?

5. If MD states leukemia would I still code to lymph nodes?


Code to bone marrow, C421.

Do not rely solely on the database. Always consult the manual and follow instructions there. Use the database as instructed in the rules.

Module 3 applies to this case based on the diagnosis of CLL/SLL. Start with the first rule in the module, Rule PH8, and stop there because PH8 fits this case.

According to the notes for Rule PH8, CLL always has peripheral blood involvement, as noted in your case (PH8 Note 1). CLL/SLL will have involvement of the lymph node regions (PH8 Note 3). Since there is extensive lymph node involvement and peripheral blood involvement in your case, code primary site C421, even though the bone marrow biopsy was not done.

The physician's documentation as Stage 0 corresponds with this case being classified as a leukemia.

In terms of the questions regarding the notes: Note 1: Since there is peripheral blood involvement, this would be CLL and assigned primary site C421. Bone marrow biopsy results are not required since there is peripheral blood involvement. Note 2: This is for SLL only. Does not apply in this situation. Note 3: This is further information about CLL/SLL, which your case fits (extension lymph node involvement). Note 6: Use Module 7 when you are coding lymphomas. If the peripheral blood was negative, this would have been SLL (lymphoma) based on the description. You would then use Module 7 to help assign primary site.


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