Home Health ICD-9/ICD-10 Alert
Watch for Pancytopenia Update
Question: How should we code pancytopenia in a patient undergoing chemo for acute myelogenous leukemia? When I look up pancytopenia in my coding manual, I'm directed to 284.1, which has an excludes note for drug induced pancytopenia (284.89). When I look at 284.89 (Other specified aplastic anemias), there is a coding tip printed in my book that says, "Code 284.89 should not be assigned without specific documentation, indicating aplastic anemia." Does the statement of chemo-induced pancytopenia qualify for using 284.89? If not, how should I proceed? California Subscriber Answer: The American Hospital Association's Coding Clinic for ICD-9-CM, 1st Quarter, 2011, answered just such a question from a reader: "If the provider documents 'pancytopenia due to chemotherapy' and there is no documentation of 'aplastic anemia,' how is this coded?" Coding Clinic answered the correct code would be 284.89, along with the appropriate E-code to identify the drug. Even though there is no medical record documentation of aplastic anemia in this scenario, coders were instructed to follow the instructional note which indicates 284.89 as the correct code for drug-induced pancytopenia. However, the 2011 ICD-9 codes went into effect on Oct. 1 of 2010, so this Coding Clinic clarification came out after your 2011 coding manual had been printed. Pancytopenia is sometimes an aplastic anemia or results from aplastic anemia. More to come: With the 2012 ICD-9 update, effective Oct. 1 of 2011, you'll have a more specific code to report for chemotherapy-induced pancytopenia. Because pancytopenia related to drugs isn't necessarily related to aplastic anemia, the 2012 update includes a specific code for this condition, 284.11 (Antineoplastic chemotherapy induced pancytopenia). You'll still report aplastic anemia due to antineoplastic chemotherapy with 284.89 when you have this specific documentation. After Oct. 1, you'll report pancytopenia due to other drugs with new code 284.12 (Other drug-induced pancytopenia). But if your patient's condition is specified as aplastic anemia due to drugs, you'll still list 284.89.
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