Oncology & Hematology Coding Alert

Question: If the oncologist documents SIRS due to cancer, what is the appropriate diagnosis coding?

Nevada Subscriber

Answer: Systemic inflammatory response syndrome, or SIRS, "generally refers to the systemic response to infection, trauma/burns, or other insult (such as cancer) with symptoms including fever, tachycardia, tachypnea, and leukocytosis," according to ICD-9 guidelines (section I.C.1.b).

To report SIRS accurately, you must report at least two codes: a code for the underlying cause (in this case, cancer) and "a code from subcategory 995.9 (Systemic inflammatory response syndrome)," ICD-9 guidelines instruct.

You should sequence the diagnosis for the underlying cause first, followed by the SIRS diagnosis. You must assign a fifth digit with 995.9 to describe the presence or absence of acute organ dysfunction.

For example, if the patient has pancreatic cancer and SIRS without acute organ failure, you would report:

- 157.0 (Malignant neoplasm of pancreas; head of pancreas) as the primary diagnosis

- 995.93 (Systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction) for SIRS without organ dysfunction.

If the physician documents SIRS with organ dysfunction, you would instead report 995.94 (Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction) for the SIRS. When reporting 995.94, you will need an additional diagnosis to specify the acute organ dysfunction (for instance, 584.5, Acute renal failure; with lesion of tubular necrosis), according to ICD-9 instructions.

If the physician fails to specify either "with" or "without" acute organ dysfunction, you will have to resort to the "unspecified" SIRS diagnosis, 995.90 (Systemic inflammatory response syndrome, unspecified).

An important distinction: Don't make the common mistake of confusing "sepsis" and "SIRS" diagnoses with infection. A patient cannot develop sepsis without first having SIRS, and SIRS does not necessarily result from infection.

-- Technical and coding advice for You Be the Coder and Reader Questions provided by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and past president of the American Academy of Professional Coders National Advisory Board.