Oncology & Hematology Coding Alert

Here’s how to navigate all the associated condition codes.

Look up anemia in the ICD-10-CM Alphabetic Index, and you’re faced with a bewildering number of potential code options. Altogether, the Index contains codes for over 300 conditions under the main entry Anemia (essential) (general) (hemoglobin deficiency) (infantile) (primary) (profound).

That means you’ll have to do some serious digging to find a more specific code than D64.9 (Anemia, unspecified). Fortunately, help is on the way in the form of this handy anemia coding guide, which features tips and tricks to help you locate the correct code quickly and easily.

Iron Out This Iron-Deficiency Anemia Excludes1 Instruction

Iron-deficiency anemia is the easiest form of anemia to code. You’ll find all the codes you need in the D50.- (Iron deficiency anemia) group. Just be sure to pay attention to the Excludes1 note accompanying D50.0 (Iron deficiency anemia secondary to blood loss (chronic)), which tells you to code D62 (Acute posthemorrhagic anemia) or P61.3 (Congenital anemia from fetal blood loss) instead if your provider documents these types of blood loss anemia.

Remember: “An Excludes1 note indicates ‘not coded here,’ as the excluded code(s) generally cannot occur at the same time as the code above the excludes note. For example, in this circumstance, D50.0 represents chronic posthemorrhagic anemia, whereas D62 would be reported for the diagnosis of acute posthemorrhagic anemia. Be sure to query the provider if it is unclear whether the blood loss anemia is acute or chronic,” says Leah Fuller, CPC, COC, senior consultant at Pinnacle Enterprise Risk Consulting Services, Kannapolis, North Carolina.

Identify Vitamin Deficiency Precisely

The vitamin-deficiency anemia codes are similarly easy to deal with. You’ll use a code from D51.- (Vitamin B12 deficiency anemia) or D52.- (Folate deficiency anemia) as appropriate. But you must also apply an additional code from the T36-T50 (Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances) group to identify the drug responsible for a patient’s folate-deficiency anemia when that anemia is caused by a drug and coded to D52.1 (Drug-induced folate deficiency anemia). That means using T45.1X5- (Adverse effect of antineoplastic and immunosuppressive drugs) for your patients experiencing this form of anemia due to chemotherapy.

Beware Instructions for Aplastic Anemia Codes

Coding for the various aplastic anemias is more challenging than coding for other forms of the condition. That’s because there are plenty of instructions to which you need to pay attention.

Take D63.0 (Anemia in neoplastic disease), for example. This code, which should be familiar to all oncology coders, has a Code first instruction telling you to code the associated neoplasm first; an Excludes1 instruction, telling you to code D61.1 (Aplastic anemia due to antineoplastic chemotherapy) if the provider documents D63.0 and D61.1 together; and an Excludes2 instruction allowing you to code D63.0 along with D64.81 (Anemia due to antineoplastic chemotherapy) if the provider documents both.

Stick to the sequence: Altogether, coding D63.0 is subject to two official guidelines that you must pay attention to:

• I.C.2.c.1 tells you to sequence the malignancy as the “principal or first-listed diagnosis followed by the appropriate code for the anemia (such as code D63.0 …)” if the “admission/encounter is for management of an anemia associated with the malignancy.”
• I.C.2.c.2 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 an adverse effect of the administration of chemotherapy or immunotherapy and the only treatment is for the anemia.”

Example: A patient reports to your oncologist with anemia, which the oncologist determines is due to the chemotherapy the patient is receiving for the cancer and not to the cancer itself. Following guideline I.C.2.c.2, “D64.81 would be the principal diagnosis in this case,” says Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, associate partner at Pinnacle Enterprise Risk Consulting Services. You would add the T45.1X5- to indicate the chemotherapy was causing the anemia, then the code for the patient’s cancer.