Oncology & Hematology Coding Alert

Question: I know anemia diagnosis coding varies based on whether anemia results from malignancy or treatment. Does diagnosis coding change based on whether dehydration is due to the neoplasm or treatment?

Pennsylvania Subscriber

Answer: Your ICD-9 coding won't change based on whether the dehydration is due to the malignancy or the therapy. The ICD-9 official guidelines state that "when the admission/encounter is for management of dehydration due to the malignancy or the therapy, or a combination of both, and only the dehydration is being treated (intravenous rehydration), the dehydration is sequenced first,followed by the code(s) for the malignancy."

What's more important for dehydration coding is knowing whether the patient presents with dehydration or hypovolemia.

Here's why: The following three codes fall under volume depletion:

• 276.50 -- Volume depletion, unspecified

• 276.51 -- Dehydration

• 276.52 -- Hypovolemia.

Dehydration: You should report 276.51 for depletion of total body water, according to ICD-9. Blood volume may be normal.

Hypovolemia: Code 276.52 is appropriate for depletion of blood volume.

If the oncologist does not specify dehydration or hypovolemia, you should choose 276.50.

Anemia tip: As you note, when the patient presents for anemia treatment (rather than dehydration), your first listed ICD-9 code does vary based on whether cancer treatment (such as chemotherapy) or the malignancy is the cause.

If the malignancy is the cause, you should choose 285.22 (Anemia of chronic disease; anemia in neoplastic disease) as a primary diagnosis. If treatment is the cause, however, you should report 284.89 (Other specified aplastic anemias) as primary. And don't forget to add E933.1 (Drugs, medicinal and biological substances causing adverse effects in therapeutic use; antineoplastic and immunosuppressive drugs).

Remember: For services on or after October 1, you'll be able to report 285.3 (Antineoplastic chemotherapy induced anemia) instead of 284.89 when chemotherapy causes anemia.