Home Health ICD-9/ICD-10 Alert

Question: We have been providing Methotrexate injections for our patient's rheumatoid arthritis. She began experiencing fatigue and weakness. At a doctor's appointment, she was diagnosed with pancytopenia secondary to drugs. The physician ordered blood monitoring with complete blood counts and liver function tests. A new medication of folic acid 5 mg weekly was also ordered. How should we code for her at recertification?

Alabama Subscriber

Answer: Pancytopenia is a medical condition in which there is a reduction in the number of red and white blood cells, as well as platelets, says Joan L. Usher, BS, RHIA, COS-C, ACE, president, of JLU Health Record Systems in Pembroke, Mass. Drug-induced pancytopenia can occur in several conditions including rheumatoid arthritis when a patient has been receiving methotrexate.

When coding Pancytopenia in the Index to Diseases, there are three options: acquired, with malformation and myelodysplastic syndrome, Usher says. Indented under pancytpopenia is due to: antineoplastic chemotherapy 284.11, drug specified NEC 284.12. These are new codes for 2012:

• 284.11 (Antineoplastic chemotherapy induced pancytopenia)

Excludes: aplastic anemia due to antineoplastic chemotherapy (284.89)

• 284.12 (Other drug induced pancytopenia)

Excludes: aplastic anemia due to drugs (284.89)

Upon recertification, you would list the following diagnoses for this patient:

M1020a: 284.12;

M1022b: 714.0 (Rheumatoid arthritis);

M1022c: E933.1 (Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use).

Pancytopenia due to non-chemotherapy drug use is coded to 284.12.

Tip: When you verify 284.12 code with the tabular list, you will see an instructional note: Excludes aplastic anemia due to drugs 284.89.

Next, list 714.0 to indicate that your patient has rheumatoid arthritis.

Finally, you'll need to list an E code for this patient because she has suffered an adverse effect from a medication properly prescribed and correctly administered. To find the right code, look under Methotrexate in the table of drugs and chemicals. Your patient's adverse effect is the result of proper therapeutic use, so the correct code is E933.1.