General Surgery Coding Alert

Question: Following a Whipple procedure involving a total pancre­atectomy that our surgeon performed to treat pancreatic cancer in the head of the pancreas, the patient developed hypoinsulinemia and diabetes. At the same time that our surgeon is providing surgical after care, the oncologist is planning chemotherapy and radiation. What diagnosis codes should we use for this case?

Ohio Subscriber

Answer: For encounters with your surgeon following the Whipple procedure, you’ll need to code first the cancer as C25.0 (Malignant neoplasm of head of pancreas). Although the cancer was surgically removed, the patient is in ongoing treatment using chemotherapy and radiation therapy, so you should not use the personal history code.

You should also indicate that the encounter is for post-procedural care by listing Z48.3 (Aftercare following surgery for neoplasm).

If the treatment is in any way directed at the complications following surgery, you should also list those conditions using the following codes:

• E89.1 (Postprocedural hypoinsulinemia) - This code instructs you to “Use additional code, if applicable, to identify acquired absence of pancreas, so you should also report:
• Z90.410 (Acquired total absence of pancreas)
• E13.9 (Other specified diabetes mellitus without complications) -- If the patient is taking insulin, you should also list:
• Z79.4 (Long term [current] use of insulin).