Home Health ICD-9/ICD-10 Alert

Question: Our patient had a Whipple procedure to treat pancreatic cancer located in the head of the pancreas. As a result of this partial pancreatectomy, the patient developed hypoinsulinemia. We are providing surgical aftercare. How should we code for him?

Minnesota Subscriber

Answer: This surgical procedure treats pancreatic cancer by removing the head of the pancreas as well as parts of other nearby organs and tissues.

To code for your patient, list V58.42 (Aftercare following surgery for neoplasm), 157.0 (Malignant neoplasm of pancreas; head of pancreas), 251.3 (Postsurgical hypoinsulinemia), and V88.12 (Acquired partial absence of pancreas).

If your patient has developed secondary diabetes as the result of the Whipple procedure, report a 249.xx category code under 251.3. Also list V58.67 (Long-term [current] use of insulin) if appropriate, the guidelines advise.

Tip: Pancreatic cancer often recurs even after surgical removal, so you can't assume the surgery has cleared up the cancer. If there is follow-up treatment such as chemotherapy or radiation, then you can assume the cancer is still there and code for it. If you're unsure, check with the physician to see whether you should list a pancreatic cancer code such as 157.0 or a V code such as V10.09 (Personal history of malignant neoplasm of gastrointestinal tract; other) to indicate a history of cancer.