Closing Casefinding Gaps in Leukemia, Lymphoma and Multiple Myeloma

Automation sees what routine workflows miss.

Real-time data turns “negative” into knowledge.

The American Cancer Society projects 2,041,910 new cancer diagnoses in 2025, with hematologic malignancies accounting for 9.5% of all leukemia, lymphoma, and multiple myeloma cases. Roughly two-thirds of these patients will undergo a bone marrow aspirate biopsy as part of staging or diagnosis. Yet, as many as 10% of those biopsied will result in a negative or normal finding and never accessioned by the registry.

To close data gaps and ensure all cases are captured, registries should:

• Review all bone marrow biopsy reports, including “negative” results
• Remove pre-filters on disease indices and update ICD-10 code lists annually
• Capture clinically significant symptom reports and labs that signal hematologic malignancy

These high-yield ICD-10 codes are most efficiently reviewed with AI-supported casefinding and intelligent abstracting, including cases with negative bone marrow biopsy results or clinical diagnoses:

• Anemia, thromboytopenia, pancytopenia: D64.9, D69.6, D61.818
• Leukocytosis: D72.820, D72.829
• Circulating blasts / abnormal cells: D72.89, R79.89
• Myelodysplastic syndromes: D46.9
• Myeloproliferative neoplasms (PV, ET, MF): D45, D47.1, D47.3
• Splenomegaly / hepatosplenomegaly: R16.0, R16.1
• Lymphadenopathy with negative biopsy: R59.0, R59.1
• Systemic “B” symptoms: R50.9, R61, R63.4
• Bone pain or lytic lesions: M89.8X, M94.8X
• Eosinophilia / basophilia: D72.1, D72.81
• Abnormal proteins, hypercalcemia, renal failure (CRAB): E83.52, N17.9, D89.2
• Abnormal chemistry, elevated LDH: R74.02, R79.89

**Actionable Tip:** Use of all the code sets for case finding is not enough. Routine quarterly or annual case-finding audits should also be conducted to ensure accuracy and completeness and to identify gaps.   

• Review MDI ICD-10 code lists for in- and outpatients to include symptoms, procedural, disease, and surveillance codes. Update the lists annually with code changes.
• Review laboratory, molecular, and genetic test results, medical oncology, infusion center, and pharmacy medication lists for any associated ICD-10 or HCPCS codes.
• Audit an unfiltered MDI, comparing encounters with ICD-10 codes to the cancer registry accession register. Note the gaps and identify root causes for the gap.
• Prepare a final report with results and an action plan. Share with your administration and Cancer Commmittee.
• Review hematology encounters, even when pathology is negative or inclusive.

In the end, every case found, even one, strengthens the integrity of cancer data and the power of care decisions.

(Note: this article was first published on LinkedIn.)