ICD 10 Coding Alert

Question: Our new 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 and diabetes. There are plans for him to have chemotherapy and radiation. We are providing surgical aftercare. How should we code for him?

Ohio Subscriber

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

To code for this patient, in ICD-9, list the following codes:

• V58.42 (Aftercare following surgery for neoplasm);
  
• 157.0 (Malignant neoplasm of head of pancreas);
  
• 251.3 (Postsurgical hypoinsulinemia);
  
• 249.0 (Secondary diabetes mellitus without mention of complication); and
  
• V88.12 (Acquired partial absence of pancreas).
  

You’ll need to list three codes to describe your patient’s hypoinsulinemia following the Whipple procedure. If your patient had any diabetic manifestations, you would need to list them in addition to the correct 249.x code.

Tip: Pancreatic cancer often recurs even after surgical removal, and in your patient’s case he will receive additional treatment directed at the neoplasm, so you should code for the neoplasm as current rather than using a V code to indicate a history of cancer.

In ICD-10, you would list the following codes for this patient:

• Z48.3 (Aftercare following surgery for neoplasm);
• C25.0 (Malignant neoplasm of head of pancreas);
• E89.1 (Postprocedural hypoinsulinemia);
• E13.9 (Other specified diabetes mellitus without complications); and
• Z90.41- (Acquired absence of pancreas).

You don’t mention whether your patient is on insulin. If he is, in ICD-9 you should list V58.67 (Long-term [current] use of insulin) and in ICD-10, you’ll report Z79.4 (Long-term [current] use of insulin).