Oncology & Hematology Coding Alert

Question: The physician saw an inpatient with chronic lymphocytic leukemia who was admitted with tumor lysis syndrome due to chemotherapy and then developed SIRS related to the cancer and resulting in acute kidney failure and acute respiratory failure. How should I report these diagnoses?

Texas Subscriber

Answer: For the tumor lysis syndrome, you should report 277.88 (Tumor lysis syndrome). Because the syndrome was secondary to chemotherapy, you also should report E933.1 (Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use).

The code for SIRS from a noninfectious cause and with organ dysfunction is 995.94 (Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction). ICD-9-CM includes a note with 995.94 to “Code first underlying conditions.” Realistically, given the complicated nature of the patient’s case, determining causes may be difficult. However, here the documentation connects the SIRS to cancer. For chronic lymphocytic leukemia, you should report 204.10 (Chronic lymphoid leukemia, without mention of having achieved remission).

You also should separately report the acute organ failure, according to a note with 995.94. Check the documentation to see if there is additional information to help you choose a specific kidney failure code from 584.5-584.8. If no additional information is available, report 584.9 (Acute kidney failure, unspecified). Use 518.81 (Acute respiratory failure) to report the acute respiratory failure.

ICD-10-CM: A similar case coded using ICD-10-CM codes could include the following:

·         E88.3, Tumor lysis syndrome

·         T45.1X5A, Adverse effect of antineoplastic and immunosuppressive drugs; initial encounter

·         C91.10, Chronic lymphocytic leukemia of B-cell type not having achieved remission

·         R65.11, Systemic inflammatory response syndrome (SIRS) of non-infectious origin with acute organ dysfunction

·         N17.9, Acute kidney failure, unspecified

·         J96.00, Acute respiratory failure, unspecified whether with hypoxia or hypercapnia.