Oncology & Hematology Coding Alert

Fatigue and malaise may not be clearly differentiated but they have separate codes.

Watch out if your physician is capturing the general complaints, like malaise and fatigue, for patients with cancer. Both the underlying cancer and chemotherapy/radiotherapy used in the treatment of cancers, are an important causative factor of malaise and fatigue.

Malaise v. fatigue: You won’t find any clear differentiation of the terms ‘malaise’ and ‘fatigue,’ and the two may be used interchangeably. Fatigue is usually described as an exertion or exhaustion. Malaise on the other hand is an unpleasant tired feeling or discomfort usually attributed to illness. “A run down feeling from illness is typically described as malaise,” says Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, Managing Director of Pinnacle Enterprise Risk Consulting Services (“PERCS”), a division of Pinnacle Healthcare Consulting.

ICD-10-CM codes: You have ICD-10-CM code R53.81 (Other malaise) for malaise and R53.83 (Other fatigue) for fatigue.

How to choose the correct code? With no clear distinction between the terms “malaise” and “fatigue,” you choose the code depending upon what your physician documents.

Key: You should not miss a diagnosis code for these two common complaints in cancer patients. It is important in the overall picture of the patient’s state of health and sometimes as important as the diagnosis codes for the cancer, associated co-morbidities and treatment(s).