Oncology & Hematology Coding Alert

Also: Get ready to fight for ESA coverage Finding the right diagnosis code for patients who develop anemia due to chemotherapy treatments has never been straightforward -- and now changes in the ICD-9 manual, effective Oct. 1, are catching coders even further off guard. Keep up with cutting-edge changes to anemia coding with this expert advice. The lowdown: Coding and billing issues become even more complex when your oncologist uses erythropoiesis-stimulating agents (ESAs) like Epogen, Procrit and Aranesp to treat chemotherapy-induced anemia. A recent coverage decision from Medicare may limit oncologists- reimbursement for ESAs. And in 2008, you-ll have to start using a whole new set of modifiers along with your ESA claims. Look for Fifth Digit on Anemia Dx Coders may have received a shock when they looked in the 2008 ICD-9 manual for a diagnosis for anemia secondary to chemotherapy. Code 284.8 (Other specified aplastic anemias) now appears with an "additional digit required" note -- leaving you to choose between the two codes below it. What to do: Choose 284.89 (Other specified aplastic anemias), says Millissa Patch, CPC, reimbursement manager at the Cleveland Clinic Taussig Cancer Center. A note beneath that code explains that it describes aplastic anemia due to chronic system disease, drugs, infection or radiation. You should use an additional E code to identify the cause, the manual says. For chemotherapy-associated anemia, report E933.1 (Primarily systemic agents; antineoplastic and immunosuppressive drugs), Patch says. You may also need to include the cancer diagnosis as a third code. Example: A patient with breast cancer develops aplastic anemia due to her chemotherapy regimen. She presents for treatment of the anemia. Report 284.89 as the primary code. Your secondary codes should include E933.1 and the appropriate neoplasm code from the 174.x range (Malignant neoplasm of female breast). Report the appropriate 90772-90775 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug] ...) code, along with the HCPCS code for the drug supply -- for example, J0885 (Injection, epoetin alfa [for non-ESRD use], 1000 units) for Epogen. Watch out: If the chemotherapy is the cause of the anemia, stay away from 285.22 (Anemia of chronic disease; anemia in neoplastic disease). "Code 285.22 is for use for anemia that is due to the malignancy, not for anemia due to antineoplastic chemotherapy drugs," say the ICD-9-CM Official Guidelines for Coding and Reporting, available at http://www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide07.pdf. However, the individual payer policy takes precedence, and it may have more specific coding guidelines to identify covered administrations. Check with your payer for its preferences. Prepare for Limitations on ESA Coding The use of ESAs to treat chemotherapy-related anemia has been attracting more attention since a July 30 national coverage determination (NCD) from the Centers for Medicare [...]