VI.1.1 Special Situations for First Course of Treatment

In Utero Diagnoses and Treatment

Beginning in 2009, the dates of diagnosis and treatment for tumors developed while in utero should reflect the dates on which they occur. In the past, these dates were assigned to the date the baby was born.

Treatment Performed Elsewhere

Record any part of the first course of treatment administered at another facility before the patient was admitted to the reporting facility or after discharge. Also record the name of the facility where the treatment was administered.

Leukemia

Leukemia is grouped or typed by how quickly the disease develops and worsens.  Chronic leukemia gets worse slowly; acute leukemia, quickly.

Leukemias are also grouped by the type of white blood cell that is affected:  lymphoid leukemia and myeloid leukemia.

First course for Leukemia and Hematopoietic Diseases

Definitions

Consolidation:  Repetitive cycles of chemotherapy given immediately after the remission.

Induction:  Initial intensive course of chemotherapy.

Maintenance:  Chemotherapy given for a period of month or years to MAINTAIN REMISSION.

Remission:  The bone marrow shows normal cellular characteristics (is normocellular), with less than 5% blasts, no signs or symptoms of the disease, no signs or symptoms of central nervous system leukemia or other extramedullary infiltration, and all of the following laboratory values within normal limits:  white blood cell count and differential, hematocrit/hemoglobin level, and platelet count.

Treatment for leukemia is divided into three phases:
  1. Remission induction (chemotherapy and/or biologic response modifiers)
  2. CNS prophylaxis or consolidation (irradiation to brain, chemotherapy)
  3. Remission continuation or maintenance (chemotherapy or bone marrow transplants)
Coding First Course of Therapy for Leukemia and Hematopoietic Diseases:
  1. If a patient has a partial or complete remission during the first course of therapy
    1. Code all therapy that is "remission-inducing" as first course
    2. Code all therapy that is "consolidation " as first course
    3. Code all therapy that is "remission-maintaining" as first course

Note:  Do not record treatment given after the patient relapses (is no longer in remission)

  1. Some patient do not have a remission.  A change in the treatment plan indicates a failure to induce remission.  If the patient does not have a remission:  
    1. Record the treatment given in an attempt to induce a remission
    2. Do not record treatment administered after the change in treatment plan

For leukemia and lymphoma cases diagnosed January 1, 2010 and forward, refer to  Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database.

 

 

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