ICD-10 Code C92.41 | Acute promyelocytic leukemia, in remission Symptoms, Diagnosis, Billing

Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia characterized by the proliferation of promyelocytes. It is associated with the presence of the promyelocytic leukemia-retinoic acid receptor alpha (PML-RARA) fusion gene, often resulting from a translocation between chromosomes 15 and 17. The condition is clinically significant due to its unique treatment response to all-trans retinoic acid (ATRA) and arsenic trioxide, which can lead to remission. The ICD-10 code C92.41 facilitates accurate diagnosis, documentation, medical billing, and public health reporting, ensuring appropriate care and resource allocation.

What is ICD-10 Code C92.41 for Acute promyelocytic leukemia, in remission?

ICD-10 Code C92.41 specifically denotes Acute promyelocytic leukemia that is currently in remission. This condition arises from the accumulation of promyelocytes in the bone marrow and is often linked to the PML-RARA fusion gene. This code should be utilized in clinical documentation and billing when a patient has achieved remission following treatment, indicating a positive response to therapy and the need for continued monitoring.

ICD-10 Code C92.41 – Clinical Definition and Explanation of Acute promyelocytic leukemia, in remission

Acute promyelocytic leukemia, in remission, is a hematological malignancy that requires prompt medical intervention. It is characterized by the rapid proliferation of promyelocytes and is often associated with coagulopathy. The condition necessitates ongoing monitoring and management to prevent relapse.

Key Clinical Features:

• Presence of promyelocytes in peripheral blood and bone marrow.
• Potential for bleeding disorders due to coagulopathy.
• Response to ATRA and arsenic trioxide leading to remission.
• Risk of differentiation syndrome during treatment.

ICD-10 Code C92.41 for Acute promyelocytic leukemia, in remission – SOAP Notes & Clinical Use

ICD-10 Code C92.41 is utilized in SOAP notes to document the patient's remission status, guiding clinical assessments and treatment plans. It plays a crucial role in both acute and chronic care settings, ensuring comprehensive documentation of the patient's condition and treatment response.

What Does ICD-10 Code C92.41 for Acute promyelocytic leukemia, in remission Mean in SOAP Notes?

In SOAP notes, ICD-10 Code C92.41 connects subjective reports of symptoms and objective clinical findings to a formal diagnosis of Acute promyelocytic leukemia in remission. This code is essential for ensuring continuity of care, supporting accurate billing, and meeting EHR documentation standards.

Treatment Options for ICD-10 Code C92.41 – Acute promyelocytic leukemia, in remission

Management of Acute promyelocytic leukemia in remission focuses on maintaining remission and preventing relapse. Treatment strategies are tailored to the individual patient's needs.

Antibiotic Therapy:

• Not applicable as APL is not an infectious condition.

Supportive Care:

• Regular monitoring of blood counts and coagulation parameters.
• Management of side effects from chemotherapy.
• Psychosocial support for patients and families.

Infection Control:

• Standard precautions to prevent infections during treatment.
• Monitoring for signs of infection due to immunosuppression.

How to Document Symptoms of Acute promyelocytic leukemia, in remission (ICD-10 C92.41) in SOAP Notes

Subjective:

• Patient reports feeling well with no current symptoms.
• Denies any bleeding or bruising.
• States adherence to follow-up appointments and treatment regimen.
• Expresses concerns about potential relapse.

Objective:

• Complete blood count shows normal white blood cell and platelet counts.
• Bone marrow biopsy indicates no evidence of leukemic cells.
• Vital signs stable with no signs of infection.
• Physical examination unremarkable.

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SOAP Note Guidelines for Diagnosing Acute promyelocytic leukemia, in remission (ICD-10 Code C92.41)

Assessment:

• Diagnosis: Acute promyelocytic leukemia, in remission.
• Severity: Currently stable with no evidence of disease.
• Triggers: Previous treatment with ATRA and arsenic trioxide.
• Monitoring for potential relapse is essential.

Plan:

• Continue regular follow-up appointments every 3 months.
• Monitor blood counts and perform bone marrow biopsies as indicated.
• Educate patient on signs of relapse and when to seek care.
• Consider genetic counseling for family planning.

Treatment & Plan Section for ICD-10 Code C92.41 – Acute promyelocytic leukemia, in remission

• First-line pharmacologic treatments include ATRA and arsenic trioxide.
• Non-pharmacologic strategies involve regular follow-up and monitoring.
• Monitoring practices include routine blood tests and physical examinations.
• Patient education on lifestyle modifications and symptom awareness.

Using ICD-10 Code C92.41 for Acute promyelocytic leukemia, in remission in Billing & SOAP Note Compliance

• Select appropriate ICD-10 codes based on clinical documentation.
• Ensure clear documentation of symptoms and treatment response.
• Align treatment plans with clinical guidelines for justified billing.
• Use CPT codes that reflect the services provided during treatment.

Related ICD-10 Codes Often Used with Acute promyelocytic leukemia, in remission

• C92.40 – Acute promyelocytic leukemia, unspecified
• C92.42 – Acute promyelocytic leukemia, not in remission

ICD-10 Code C92.41 in Medical Billing and Insurance for Acute promyelocytic leukemia, in remission

ICD-10 Code C92.41 is crucial for accurate billing in hospital, ER, or infectious disease care settings.

Billing Notes:

• Document all relevant clinical findings to support the use of this code.
• Ensure the code is used in appropriate clinical settings for accurate claims.
• Include key elements in the chart such as treatment response and follow-up plans.

Common CPT Pairings: