Oncology & Hematology Coding Alert

Official guidelines add some important changes effective Dec. 1

Quick quiz: Should you report 285.22 for anemia due to a neoplasm or due to cancer treatment? 

Find the answers to this--and other anemia coding questions--in the three examples below, taken from the latest update to the -ICD-9-CM Official Guidelines for Coding and Reporting .-

These guidelines, provided in part by CMS, went into effect Dec. 1, 2005, so start implementing them today.

1. Report 285.22 as Primary for Anemia Encounter

Additions to the ICD-9 coding guidelines clarify that you should report 285.22 (Anemia in neoplastic disease) as the principal diagnosis when a patient presents with anemia associated with a malignancy and is only treated for the anemia.

You should report the code for the malignancy as a secondary diagnosis code, according to -Chapter 2: Neoplasms (140-239).- Why: When you report 285.22 (or any code from the 285 subcategory), you must code for the chronic condition causing the anemia. You-ll find this rule in -Chapter 4: Diseases of the Blood and Blood-Forming Organs (280-289).- (You can download these guidelines at www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide05.pdf.)

Example: An ovarian cancer patient presents with anemia due to intratumor bleeding. The oncologist treats her only for the anemia at this encounter.

What to do: Report the anemia as your principal diagnosis with 285.22. Then report the appropriate malignancy code, such as 183.0 (Malignant neoplasm of ovary), says Michael Berman, MD, FACOG, FACS, professor of gynecologic oncology at the University of California, Irvine.

2. Code 285.22 Second for Neoplasm Treatment

The guidelines for -anemia of chronic disease- also tell you that you may report the anemia diagnosis as a secondary code if anemia treatment is a portion of the encounter, but not the primary reason for it.

Example: A patient presents for chemotherapy to treat his stomach cancer, which is present at contiguous sites. Blood loss related to the cancer has resulted in anemia, and the oncologist treats this at the same encounter.

What to do: The primary reason for the encounter is chemotherapy, so report V58.11 (Encounter for antineoplastic chemotherapy). Then report the anemia (285.22) and the malignancy (151.8, Malignant neoplasm of stomach; other specified sites of stomach).

Important: These guidelines specify that 285.22 is for use for anemia that is due to the malignancy, not for anemia due to antineoplastic chemotherapy drugs, which is an adverse effect. If your patient has anemia because of the adverse effect of treatment, see below.

3. Try E Code for Treatment-Related Anemia

Patients often experience anemia due to chemotherapy treatment, says Garnet Dunston, CPC, MPC, past secretary-treasurer of the American Academy of Professional Coders.

In this situation, chapter 2 of the most recent guidelines tells you to report the anemia, then E933.1 (Drugs, medicinal, and biological substances causing adverse effects in therapeutic use; antineoplastic and immunosuppressive drugs) and the appropriate code for
the neoplasm.

Example: A patient with breast cancer develops aplastic anemia due to her chemotherapy regimen. She presents for treatment of the anemia.

What to do: Report the aplastic anemia with the appropriate code from the 284.x range (Aplastic anemia) as the primary code. Your secondary codes should include E933.1 and the appropriate neoplasm code from the 174.x range (Malignant neoplasm of female breast).

Previous ICD-9 guidelines instructed you to sequence the anemia first when a patient presented only for treatment of an anemia associated with chemotherapy or radiotherapy. The new guidelines add immunotherapy to that list.

Remember, although these are the -official- guidelines, your payer has the final say on proper coding for its claims.