# Help with Anemia codes



## LTibbetts (Feb 24, 2011)

Can you code more than one type of anemia on a single chart? For example; if the patient has neoplastic anemia, but they also have a chronic anemia due to CKD that existed before the cancer. Is it ok to use more than one if they are in different subsections of the anemia codes (i.e., 282, 283, 285)?


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## mitchellde (Feb 24, 2011)

Is it documented as anemia due to the neoplasm?  or is it possible that the anemia they had due to the CKD has been exacerbated by the chemo treatments.  Chemo induce anemia is not the same thing as neoplasm anemia.  So it all depends.  Or do they have something else like decreased white cells or a decrease of platelets?  or possibly now they have pancytopenia.    It would help to know exactly how the provider documented this.


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## LTibbetts (Feb 24, 2011)

Hi Deb,
Actually, I was just using that as an example. My real question was just about how many different types of anemias can you code on one chart. What if they only document that the patient has CKD, stage III and anemia due to that, and also another type of anemia, such as iron defficiency or something like that? Is it possible to code both?

I have one account here that I am working on where it says "anemia of a chronic disease with super-imposed iron def anemia for which the patient recieves inron infusions. Should her iron studies be found to be normal, we will give the patient Aranesp for her chemo-induced anemia"

Is the doc saying that they are just not sure which anemia is causing the problem? But, since the patient is being treated for the iron-def anemia currently, does that mean I can code both?


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## mitchellde (Feb 24, 2011)

You might want to query the physician, but from working in the cancer center what the docs told me is... most of the time the chemo casues the anemia (need an E code too), if it were related to the disease process they will say so.  Also you do not have an iron deficient anemia and an anemia cause by treatment together, an iron deficient anemia is caused by a deficiency in the patient's diet or metabolic system not storing enough iron for the bodies needs.  While most anemias are deficient in iron they are not all iron deficient anemia disorders.  So in the grand scheme of things I will say no you cannot have two different kinds of anemia in the sense that your example goes.  Thant is chemo induced and iron deficient.  They either have an iron deficiency exacerbated by the the treatment or they have treatment related anemia.


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## LTibbetts (Feb 24, 2011)

Ok, thanks, Deb.
But a the risk of sounding redundant...is there ever a situation that would call for more than one anemia code on an account?


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## mitchellde (Feb 24, 2011)

I cannot think of any.  other than an anemia and a leukopenia.  but just straight anemia, I cannot think of a scenario where you would code more than one.  MDS includes anemia as one of its symptoms, so even then you just code the MDS.  I am certain there will be many that will post here that say this is incorrect, but I always go back to the documentation, code what is documented not what you want to get the claim paid.


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## ohn0disaster (Feb 24, 2011)

What if the doctor is documenting the anemia as a seperate identity? 

This is a big problem for me, especially with MDS. In fact, I have posted several posts in the forums trying to get some assistance in this subject.

Also, this post brought this subject back up for me so I decided to go have a conversation, at length, with one of my physicians. He insists that you can have 2 different types of anemia at once. I brought up the example of "Ok so, say the patient has anemia due to CKD stage III. Can they have Iron Deficiency Anemia also?" His answer was, "Yes, absolutely." Then he looked at me like I had grown a second head and told me that he would have thought that I would have been able to come to that conclusion on my own, very easily, but we won't get into all that.... (he can be such a ___ ) Lol. I told him I'd get back to him on that when I earned my medical degree. Thinking about it now though, why wouldn't it be possible to develop more than one type of anemia when their causes, as well as treatment methods, are different?

______________________________

I would definitely talk to the physician and see what his/her stance on this subject is. I know that's not possible for some of you guys though. I sure am glad that I have a good relationship with my docs and that they are so easily accessible to me when I need to talk to them about something. You should see some of the documentation I have to deal with sometimes... some of it just doesn't make sense.


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## LTibbetts (Feb 24, 2011)

mitchellde said:


> I cannot think of any.  other than an anemia and a leukopenia.  but just straight anemia, I cannot think of a scenario where you would code more than one.  MDS includes anemia as one of its symptoms, so even then you just code the MDS.  I am certain there will be many that will post here that say this is incorrect, but I always go back to the documentation, code what is documented not what you want to get the claim paid.



Ok, thanks again Deb. I really appreciate your input....as always!!


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## mitchellde (Feb 24, 2011)

ohn0disaster said:


> What if the doctor is documenting the anemia as a seperate identity?
> 
> This is a big problem for me, especially with MDS. In fact, I have posted several posts in the forums trying to get some assistance in this subject.
> 
> ...



IF the physician documents clearly that there is an iron deficient anemia AND an anemia due to CKD, then I would not contradict him.  But it must be clearly documented and not inferred.  I have never had more than one kind documented and the physicians I worked with at the cancer center were clear to us that MDS included the anemia and we were not to code it as a separate dx.  So while I could not think of any circumstance, by all means if clearly documented then yes code it.  What I cation against is making an inference of iron deficiency just to get a claim to pay and that is what I see happen most often.  With Chemo induced anemia, the doc told me "of course the patient is deficient in iron, the chemo took care of it , and now we have to replace it!"  He went on to give an entire lesson on what is iron deficient anemia.  I am so sorry you have to work such a rude kind of physician, the good ones are worth their weight for sure!


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