General Surgery Coding Alert

Question: A patient developed hypoinsulinemia and diabetes after our surgeon performed a Whipple procedure involving a total pancreatectomy to treat pancreatic cancer in the head of the pancreas. Our surgeon is providing surgical aftercare, while, simultaneously, an 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 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.

However, the primary diagnosis would be the indication that the encounter is for post-procedural care by listing Z48.3 (Aftercare following surgery for neoplasm).

Note: If the treatment is in any way directed at the complications following surgery, you should “designate the complication as the principal or first-listed diagnosis if the treatment is directed at resolving that complication,” according to the ICD-10-CM Official Guidelines for Coding and Reporting.

First, report E89.1 (Postprocedural hypoinsulinemia). This code instructs you to “Use additional code, if applicable, to identify: acquired absence of pancreas (Z90.41-), diabetes mellitus (postpancreatectomy) (postprocedural) (E13.-), insulin use (Z79.4)” so you should also report:

• Z90.410 (Acquired total absence of pancreas);
• E13.9 (Other specified diabetes mellitus without complications); and/or
• Z79.4 (Long term [current] use of insulin), if applicable.