Oncology & Hematology Coding Alert

Discover which condition is more likely to be caused by chemotherapy.

Patients with cancer may develop anemia from a number of causes. Here are some clues to help you pinpoint the source and keep your coding compliant.

Flashback: Last month, Oncology & Hematology Coding Alert, vol. 13, no. 9, discussed coding treatment of anemia caused by cancer (see "Part 1: 285.22 Scenario Reveals Importance of Following Official Guidelines").

This article digs deeper into proper anemia coding, looking at codes for anemia caused by treatment and at how guidelines are expected to change when ICD-10 use becomes mandatory in 2013.

Double Check Documentation Before You Assign 284.89

When documentation shows that antineoplastic chemotherapy caused a patient's anemia, you need to consider two codes:

• 285.3, Antineoplastic chemotherapy induced anemia
• 284.89, Other specified aplastic anemias, due to drugs.

The main difference between the two is that 284.89 references "aplastic" anemia. "Aplasia implies that the bone marrow is 'wiped out,'" according to Coding Clinic for ICD-9-CM (2009, vol. 26, no. 4).

Antineoplastic chemotherapy induced anemia "is not usually an aplastic process," Coding Clinic states. The anemia is likely to be short term, but it may range from mild to severe. So 285.3 may apply to your patient's claims more often than 284.89, but you should let documentation direct your choice. Before you assign 284.89, be sure the documentation shows the anemia is aplastic and due to drugs.

Helpful: Referring to the ICD-9 notes for information is a key aspect of proper coding, says Lisa S. Martin, CPC, CIMC, CPC-I, chargemaster specialist for OSF Healthcare System in Peoria, Ill.

For example, an "excludes" note under 285.3 instructs you instead to use 284.89 for "aplastic anemia due to antineoplastic chemotherapy." (As discussed in Part 1, another 285.3 excludes note points you to 285.22, Anemia in neoplastic disease, when the neoplasm causes the anemia.)

Bonus tip: Because 285.3 specifies chemotherapy as the cause of the anemia, Coding Clinic states you don't need to add E933.1 (Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use) to your claim. Code 285.3 sufficiently explains that the condition is an adverse effect of chemotherapy. If your practice chooses to use the E code for internal data collection, that's a valid option, according to the article.

Expect a Shake-Up When ICD-10 Begins

Last month's article (Part 1) explained the sequencing rules for ICD-9 codes when a patient presents for treatment of anemia due to a neoplasm.

Paying attention to such diagnosis coding guidelines will become even more important as you prepare to use ICD-10 instead of ICD-9. In particular, the ICD-10 2011 guidelines for anemia coding differ from those you know for ICD-9.

Example 1: A patient presents for treatment of anemia only. The physician documents that the patient's neoplasm caused the anemia to develop.

Under ICD-9 2011 guidelines, your first-listed code should report the anemia (285.22). The appropriate malignancy code(s) should follow (ICD-9, Section I.C.2.c.1).

If you were instead applying ICD-10 2011 guidelines, you would report the malignancy code first and then the anemia code, D63.0 (Anemia in neoplastic disease) (ICD-10, Section I.C.2.c.1).

Example 2: Another patient presents for treatment of anemia only. For this patient, the physician documents that the anemia is due to chemotherapy or immunotherapy.

Using ICD-9 guidelines, your first-listed code should represent anemia (such as 285.3). You should report the neoplasm as an additional code (ICD-9, Section I.C.2.c.2).

In contrast, the 2011 ICD-10 guidelines instruct you to use an adverse effect code as your first-listed code. Your anemia and neoplasm codes should follow that (ICD-10, Section I.C.2.c.2).

Remember: The guidelines above reflect ICD-10 2011 guidelines. When ICD-10 goes into effect on Oct. 1, 2013, you will apply the official ICD-10 coding guidelines in effect for the relevant date of service.

You can download the 2011 ICD-10 guidelines from CMS's ICD-10 site: www.cms.gov/ICD10/12_2010_ICD_10_CM.asp. You also can download them from the CDC's ICD-10-CM site: www.cdc.gov/nchs/icd/icd10cm.htm#10update. ICD-9 guidelines are available at www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm.