Oncology & Hematology Coding Alert

Question: I read an article that said ICD-10 guidelines for anemia/neoplasm coding differ from ICD-9. Where can I access the ICD-10 guidelines?

Answer: You can download the 2010 ICD-10 guidelines from CMS's ICD-10 site: www.cms.gov/ICD10/12_2010_ ICD_10_CM.asp. You also can download them from the CDC's ICD-10-CM site: www.cdc.gov/nchs/icd/icd10cm.htm#10update.

Remember: When ICD-10 goes into effect on Oct. 1, 2013, you will apply the official ICD-10 coding guidelines in effect for the relevant date of service.

The anemia/neoplasm differences that you refer to most likely relate to coding anemia associated with a malignancy (when the encounter is for the anemia) and coding adverse effects.

Neoplasm/anemia scenario: Suppose a patient has anemia associated with a malignancy, and she presents for treatment of the anemia only.

ICD-9: ICD-9 guidelines state that your first-listed code should be for anemia, 285.22 (Anemia in neoplastic disease). Then, the guidelines instruct you to report the appropriate malignancy code(s) (ICD-9, Section I.C.2.c.1, www.cdc.gov/nchs/data/icd9/icdguide10.pdf).

ICD-10: ICD-10 guidelines, on the other hand, instruct you that in the above scenario, you must report the malignancy first and then the anemia code, D63.0 (Anemia in neoplastic disease) (ICD-10, Section I.C.2.c.1).

Treatment/anemia scenario: Suppose a patient has anemia caused by his chemotherapy, immunotherapy, or radiotherapy, and he presents for treatment of the anemia only.

ICD-9: You should sequence the anemia first (such as 285.3, Antineoplastic chemotherapy induced anemia), according to ICD-9 guidelines. Then report the appropriate neoplasm code (ICD-9, Section I.C.2.c.2). In addition, when the patient has an adverse reaction to a correctly prescribed and administered substance, ICD-9 instructs you to code the reaction followed by a code from E930-E949 (ICD-9, Section I.C.19.c). For example, you might report E933.1 (Drugs, medicinal, and biological substances causing adverse effects in therapeutic use; antineoplastic and immunosuppressive drugs).

ICD-10: Your first-listed code should be an adverseeffect code, under ICD-10. Then report the anemia and neoplasm codes (ICD-10, Section I.C.2.c.2).

Bottom line: The ICD-10 change isn't just about new codes. Stay alert for changes to guidelines, as well. Get a head start by reading through the ICD-10 official guidelines that apply to the diagnoses you report most often. Consider highlighting differences in the logic and sequencing as you read through and compare for a more comprehensive understanding of important changes, especially for the codes you use most often for your specialty.