ICD-10 Coding for History of Chronic Lymphocytic Leukemia(Z85.71, C91.11)
Complete ICD-10-CM coding and documentation guide for History of Chronic Lymphocytic Leukemia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to History of Chronic Lymphocytic Leukemia
Z85.71Primary Range
Personal history of leukemia
Used when the patient has a history of leukemia but no current active disease.
Chronic lymphocytic leukemia codes
Used for active, in remission, or relapsed states of CLL.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Z85.71 | Personal history of leukemia | Use when the patient has a history of leukemia but is not currently undergoing treatment or showing signs of active disease. |
|
| C91.11 | Chronic lymphocytic leukemia, in remission | Use when the leukemia is in remission and documented as such. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for history of chronic lymphocytic leukemia
Essential facts and insights about History of Chronic Lymphocytic Leukemia
Primary ICD-10-CM Codes for history of chronic lymphocytic leukemia
Decision Criteria
documentation Criteria
- Document 'history of leukemia' with no current treatment or symptoms.
Clinical Validation Requirements
- No active treatment for leukemia
- Normal lymphocyte counts
- No evidence of disease on recent tests
Code-Specific Risks
- Misclassification if the leukemia is in remission but not documented as such.
Coding Notes
- Ensure documentation clearly states 'history of' to avoid confusion with active disease.
C91.11 - Chronic lymphocytic leukemia, in remission
Use when the leukemia is in remission and documented as such.
Applicable To
- CLL in remission
Excludes
- Active CLL (C91.10)
Clinical Validation Requirements
- Documented remission status
- Recent lab results showing remission indicators
Coding Notes
Ensure remission is clearly documented to support this code.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting History of Chronic Lymphocytic Leukemia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z85.71.
Impact
Clinical: Misrepresentation of patient's current health status., Regulatory: Non-compliance with coding standards., Financial: Potential for incorrect billing and reimbursement.
Mitigation Strategy
Regularly update patient records., Ensure documentation includes remission status.
Impact
Reimbursement: May lead to incorrect reimbursement if remission is not coded., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Ensure remission is documented and use C91.11 if applicable.
Impact
Failure to document remission status can lead to audit issues.
Mitigation Strategy
Ensure all remission cases are documented with supporting lab results.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for History of Chronic Lymphocytic Leukemia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for History of Chronic Lymphocytic Leukemia
Use these documentation templates to ensure complete and accurate documentation for History of Chronic Lymphocytic Leukemia. These templates include all required elements for proper coding and billing.
Patient with history of CLL
Specialty: OncologyRequired Elements
- Patient history
- Current status
- Recent lab results
- Treatment history
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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