Oncology & Hematology Coding Alert

Choose among 3 options when the code set changes.

When sickle cell anemia results in crisis, your coding needs to identify whether the physician diagnosed acute chest syndrome or splenic sequestration. Here's how the method of reporting the crisis differs between ICD-9-CM and ICD-10-CM.

ICD-9-CM Code

• 282.62, Hb-SS disease with crisis

ICD-10-CM Codes

• D57.00, Hb-SS disease with crisis, unspecified
• D57.01, Hb-SS disease with acute chest syndrome
• D57.02, Hb-SS disease with splenic sequestration

Diagnosis: Hb-SS is a sickle cell disease in which the patient has inherited a sickle cell gene ("S") from each parent. Sickle cell anemia is another name for this disease.

ICD-9-CM coding rules: ICD-9-CM has one code for Hb-SS disease with crisis. It is appropriate for Hb-SS disease with vaso-occlusive pain and sickle-cell crisis NOS (not otherwise specified). Under ICD-9-CM, you use a separate code to indicate the type of crisis:

• 289.52, Splenic sequestration
• 517.3, Acute chest syndrome.

ICD-10-CM changes: ICD-10-CM will allow you to report both the Hb-SS and the type of crisis (acute chest syndrome or splenic sequestration) using a single code. The D57.0- codes are appropriate for Hb-SS disease with crisis, sickle-cell disease NOS with crisis, and Hb-SS disease with vaso-occlusive pain.

Documentation: To choose the most specific ICD-10-CM code, you would need to know both that the patient has Hb-SS disease and the nature of the crisis: acute chest syndrome (circulation is obstructed by sickle cells) or splenic sequestration (sickle cells trap blood within the spleen causing enlargement). Without that information you would have to choose the unspecified code.

Coder tips: When reporting D57 codes, ICD-10-CM instructs you to use an additional code for any associated fever (R50.81, Fever presenting with conditions classified elsewhere).

Remember: CMS has finalized the ICD-10-CM compliance date of Oct. 1, 2014. When ICD-10-CM goes into effect, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.