Oncology & Hematology Coding Alert

Anemia and cancer go hand-in-hand. In patients suffering from cancers such as lymphoma, leukemia, and myeloma, the cancer causes the anemia, as the affected bone marrow decreases blood cell production, or the blood cells are weakened to the point where they no longer help the immune system fight off infection. In other patients, anemia is one of the side effects they may experience from the therapy they are receiving to treat the cancer.

Coding these cause-and-effect situations is reflected in the ICD-10-CM guidelines. So, you need to pay careful attention to the following two specific chapter-specific instructions whenever your provider documents a patient with anemia.

Let I.C.2.c.1. Guide Your Anemia Caused by Cancer Coding

The pertinent guideline in this situation tells you “when admission/encounter is for management of an anemia associated with the malignancy, and the treatment is only for anemia, the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis followed by the appropriate code for the anemia.” In this case, you are instructed to use a code such as D63.0 (Anemia in neoplastic disease).

Encounter 1: Your provider treats a patient for anemia, which is documented as a complication of the patient’s prostate cancer. In this scenario, the ICD-10-CM guideline tells you to code the cancer first, which you would document with C61 (Malignant neoplasm of prostate) followed by the D63.0.

But remember this: Anemia is the only cancer complication requiring you to report the neoplasm code first in the sequence. Per ICD-10-CM guideline Table I.C.2.c., when a patient is treated for a complication associated with a neoplasm, and that complication is not anemia, then you will code the complication first followed by the neoplasm.

So, a patient who has developed candidiasis as a consequence of acute myeloid leukemia (AML) would be coded with B37.9 (Candidiasis, unspecified) along with a code from C92.0- (Acute myeloblastic leukemia).

Defer to I.2.c.2. for Anemia Caused by Chemo-, Immuno-, and Radiation Therapy

In situations where the patient’s anemia is due to therapy, this guideline tells you to sequence the anemia code first, “followed by the appropriate codes for the neoplasm and the adverse effect … when the admission/encounter is for management of an anemia associated with” the therapy.

But in this situation, your code choice will depend on the kind of therapy the patient is receiving. The guideline instructs you to use T45.1X5- (Adverse effect of antineoplastic and immunosuppressive drugs) to indicate the anemia is an adverse effect of the administration of chemotherapy or immunotherapy. However, “when the admission/encounter is for management of an anemia associated with an adverse effect of radiotherapy,” you are instructed to use Y84.2 (Radiological procedure and radiotherapy as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure) to document the external cause of the anemia.

Don’t forget: When using T45.1X5-, you will need to add the appropriate seventh character — A (initial encounter), D (subsequent encounter), or S (sequela) — to indicate the episode of patient care.

Encounter 2: This time, your provider sees a female patient who is taking chemotherapy for breast cancer in the central portion of her right breast. In the encounter, the provider treats the patient for anemia due to the chemotherapy. It is the patient’s first encounter for this particular condition.

Here, your coding will look like this:

• D64.81 (Anemia due to antineoplastic chemotherapy)
• C50.111 (Malignant neoplasm of central portion of right female breast)
• T45.1X5A

Why D64.81? In a scenario like this, you may be tempted to use another code for the chemotherapy-induced anemia: D61.1 (Drug-induced aplastic anemia). However, this choice is likely to be incorrect because “antineoplastic chemotherapy induced anemia is anemia caused by the administration of cancer drugs. This type of anemia is rarely a hemolytic process and is not usually an aplastic process,” according to AHA ICD-9-CM/ ICD-10-CM Coding Clinic 2009 (Vol. 26, no. 4).

This suggests D64.81 is the more likely code than D61.1 to use in scenarios like this, though the Coding Clinic article does tell you to “let documentation direct your choice,” and “be sure the documentation shows the anemia is aplastic and due to drugs.”

Encounter 3: A patient develops anemia after receiving radiation therapy for thyroid cancer. In this example, you would code:

• D63.0
• C73 (Malignant neoplasm of thyroid gland)
• Y84.2