Oncology & Hematology Coding Alert

Question: I-ve been reporting the neoplasm diagnosis code along with V58.11 for chemotherapy patients being treated for anemia. The February issue of Oncology Coding Alert said to report another code. Can I stick with what works?

Indiana Subscriber

Answer: Careful -- just because you get paid for coding a certain way doesn't mean it's appropriate.
 
The official ICD-9 coding guidelines (www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide05.pdf) state that you should report 285.22 (Anemia in neoplastic disease) as the principal diagnosis when a patient presents with malignancy-associated anemia and is only treated for the anemia. You should also report the code for the malignancy as a secondary diagnosis code, according to -Chapter 2: Neoplasms (140-239),- to comply with the rule to report the chronic condition causing the anemia.
 
The guidelines for -anemia of chronic disease- also state 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.
 
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, chapter 2 of the most recent guidelines states, you should 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.
 
You should follow the official guidelines unless your payer has instructed you -- in writing -- to code a different way.