Oncology & Hematology Coding Alert

Vomiting without nausea and vomiting NOS will have separate codes.

When physicians document chemotherapy-induced nausea and vomiting (CINV), you have a number of ICD-9-CM codes to choose from, and you won’t find the selection any smaller under ICD-10-CM.

ICD-9-CM Codes

536.2, Persistent vomiting

       o 
Persistent vomiting [not of pregnancy], Uncontrollable vomiting

569.87, Vomiting of fecal matter

787.01, Nausea with vomiting

787.02, Nausea alone

787.03, Vomiting alone

787.04, Bilious emesis

       o  Bilious vomiting

ICD-10-CM Codes

R11.0, Nausea

       o  Nausea NOS, Nausea without vomiting

R11.10, Vomiting, unspecified

       o  Vomiting NOS

R11.11, Vomiting without nausea

R11.12, Projectile vomiting

R11.13, Vomiting of fecal matter

R11.14, Bilious vomiting

       o  Bilious emesis

R11.2, Nausea with vomiting, unspecified

       o  Persistent nausea with vomiting NOS

ICD-9-CM coding rules: ICD-9-CM includes several nausea and vomiting codes under 787.0x. But for persistent vomiting and vomiting of fecal matter, you have to look beyond 787.0x to 536.2 and 569.87 respectively.

ICD-10-CM changes: Under ICD-10-CM, you’ll turn to the R11.- range for many nausea and vomiting codes. Note that persistent nausea with vomiting is included under R11.2. The code for vomiting of fecal matter is also conveniently grouped into the range at R11.13.

Documentation: The provider should specifically document whether nausea is absent or present and whether vomiting is absent or present to help you choose the most specific code. And because not all vomit is created equal, the physician should specifically document bilious vomiting or vomiting of fecal matter. Under ICD-10-CM, there’s also a code specific to projectile vomiting, if that is documented.

Coder tips: Keep in mind that ICD-10-CM, like ICD-9-CM, has other codes related to nausea and vomiting. You should search the index and tabular list to be sure you have the appropriate code for the patient’s specific condition. For instance, ICD-10-CM includes K91.0 (Vomiting following gastrointestinal surgery) and ICD-9-CM has 564.3 with the same definition.

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.