Oncology & Hematology Coding Alert

Question: The only information related to diagnosis we have for one of our new hematology patients is that he bruises easily, sometimes with no apparent reason. Tests have yet to confirm something more definitive.  Which ICD- 9 code should I report?

Iowa Subscriber

Answer: Because the hematologist has yet to identify a specific disease, you'll need to report the patient's symptoms.

For easy bruising with no identifiable cause, consider 782.7 (Spontaneous ecchymoses). An ecchymosis is a bruise larger than 1 centimeter. According to a note with the code, 782.7 applies also to petechia, which is a bruise less than 3 millimeters.

Another option: A bruise less than 1 centimeter but not less than 3 millimeters is called a purpura, which has several other coding options (287.0-287.9, Purpura and other hemorrhagic conditions) depending on the etiology (meaning the cause or origin).

An "easy bruising" individual may suffer from other diseases that predispose him to develop bruises even with minimal trauma, such as a light rap on the hands, which would not bruise a normal, healthy individual. Possible causes include platelet or coagulation disorders (thrombocytopenias), bone marrow disorders, and hemophilias.Even aging and medications (for example, aspirin, prednisone, and other nonsteroidal anti-inflammatory drugs) can cause easy bruising. For patients suffering from these conditions, bruises seem to spontaneously appear without any identifiable cause. If the hematologist determines the cause and documents it, then you should report that disease.

ICD-10 tip: Your coding options will look different if payers implement ICD-10 use in 2013, as expected. ICD-10 2010 lists R23.3 (Spontaneous ecchymoses). As under ICD-9, this code also represents petechia. ICD-10's purpura codes fall under D69.x (Purpura and other hemorrhagic conditions). You can check out ICD-10 2010 at www.cdc.gov/nchs/icd/icd10cm.htm#10update.