Distinguishing between History of vs. In remission for Certain Blood Cancers

Leukemia, lymphoma, and multiple myeloma are all types of blood cancers, but they affect different types of blood cells and have unique characteristics. Leukemia involves the rapid growth of abnormal white blood cells, lymphoma affects lymphocytes, and myeloma affects plasma cells, which produce antibodies.

With the recent expansion on Lymphoma to include “in remission,” it’s important to understand when to use “history of” versus “in remission.”

From a coding professional’s perspective, if the physician’s documentation states “history of” or the site of disease has been eradicated, treatment has been completed, and the patient is declared “cancer free,” we use the “history of” codes. Alternatively, if the patient is documented as having achieved complete remission or partial remission, we would use the “in remission” code.

The National Cancer Institute defines in remission as: “A decrease in or disappearance of signs or symptoms of cancer. Partial remission, some but not all signs and symptoms of cancer have disappeared. Complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body.”[i] 

Are there any other terms that we can look for to indicate when to use “in remission” other than “remission”?

The University of Texas MD Anderson Cancer Center published an article entitled, “Remission, cancer-free, no evidence of disease: What’s the difference?” And they explained that “remission” and “no evidence of disease,” also known or abbreviated as NED, both mean that no cancer is currently detectable in the body.  This may be based on scans, bloodwork, or other tests.[ii]

 “Cancer free” terminology implies there is no residual cancer left anywhere, thus is now considered “personal history.” In using this information, coding professionals could draw a link between documented “no evidence of disease” and “in remission.”

The American Hospital Association’s (AHA’s) Coding Clinic 2024, 4^th Qtr. suggests that using “no evidence of disease” also equates to “in remission.”   It further states: ” The focus of lymphoma treatment is to induce complete remission by destroying lymphoma cells. 

Complete remission means that all evidence of disease has been eliminated.” This is your NED. Of course, if the documentation is unclear whether the lymphoma, leukemia, or myeloma is “in remission” or “history of,” a query should be sent to the physician.

ICD-10-CM Official Guidelines for Coding and Reporting Section I.C.2.g.l.n. ends by stating, “If the documentation is unclear as to whether the leukemia has achieved remission, the provider should be queried.”[iii]

Is there any value in using the “in remission” code instead of the “history of” code.  Yes!  “In remission” will impact the DRG by adding a complication or comorbidity (CC) to the case.   And in the cases where APR/DRGs are being used, the “in remission” code can carry weight, which, in turn, can impact the severity of illness (SOI) or risk of mortality (ROM). Using the “history of” codes do not have the same impact.

This, in turn, provides clinical documentation integrity (CDI)departments with an opportunity to educate providers in the importance of having clear and concise documentation and how it may impact the bottom line. Having clarity in the use of “history of” versus “in remission” allows coders to be precise in their coding activities.

Programming note:

Listen to Amy Jo Combs report this story live today during Talk Ten Tuesday with Chuck Buck and Angela Comfort, 10 Eastern.

[i] National Cancer Institute. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/remission

[ii] Demarco, C. Remission, cancer-free, no evidence of disease: What’s the difference? 5/12/21. https://www.mdanderson.org/cancerwise/remission–cancer-free–no-evidence-of-disease–what-is-the-difference-when-talking-about-cancer-treatment-effectiveness-and-results.h00-159460845.html 

[iii]  CD-10-CM Official Guidelines for Coding and Reporting. 2017. https://www.cms.gov/medicare/coding/icd10/downloads/2017-icd-10-cm-guidelines.pdf

Other resources:  Bredehoeft, E.  Clear Up Confusion as to When Cancer Becomes “History of.” November 1, 2017.  AAPC Knowledge Center. https://www.aapc.com/blog/40016-clear-up-confusion-as-to-when-cancer-becomes-history-of/?msockid=27f4c9a5238363931ad6dc6f22086263