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Source 1: Subject matter expert
Histology-Heme & Lymphoid Neoplasms: I have a question regarding question 20110035.
The answer to this question is opposite of what we have been coding for years. I am not opposed to the change, I just want to know why after all the years of coding SLL/CLL (Small Lymphocytic Lymphoma/Chronic Lymphocytic Leukemia) to lymphoma 9670/3 when both tissue and bone marrow/blood are involved to now coding to leukemia 9823/3. I know the hematopoietic rules have changed but sometimes it is nice to know why.
Yes, there has been a change in coding practice based on a change in clinical classification of leukemia/lymphomas. In the past, we did, indeed, default to lymphoma when both tissue and bone marrow were involved. The problem was that when only bone marrow was involved, the case was coded to leukemia with a primary site of bone marrow. When lymphoma symptoms developed later, there was a lot of inconsistency in how registries handed these cases. Some coded a new primary "lymphoma;" while others ignored the lymphoma calling it progression. The clinical world, including the hematopoietic experts on the World Health Organization and the Inter-lymph consortium agreed that for certain neoplasms(CLL/SLL being one of them) it was not useful or practical to code the leukemia and lymphoma separately OR to capture only one of the neoplasms(because these neoplasms almost always progress to lymphoma); so new codes for the leukemia/lymphoma were developed. According to the experts, this code most accurately portrays the neoplastic process for the neoplams assigned to a lymphoma/leukemia code.