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 E88.3 (Tumor lysis syndrome). Because the syndrome was secondary to chemotherapy, you also should report T45.1X5A (Adverse effect of antineoplastic and immunosuppressive drugs; initial encounter)

The code for SIRS from a noninfectious cause and with organ dysfunction is R65.11 (Systemic inflammatory response syndrome (SIRS) due to non-infectious origin with acute organ dysfunction). ICD-10-CM includes a note with R65.11 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 C91.10 (Chronic lymphocytic leukemia of B-cell type not having achieved remission).

You should use additional codes to report the acute organ failure, according to a note with R65.11. Check the documentation to see if there is additional information to help you choose a specific kidney failure code from N17-N19 (Acute kidney failure and chronic kidney disease). If no additional information is available, report N17.9 (Acute kidney failure, unspecified). Use J96.00 (Acute respiratory failure, unspecified whether with hypoxia or hypercapnia) to report the acute respiratory failure.