Oncology & Hematology Coding Alert

Reader Questions:

Pay Attention to Neoplasm Sign and Symptoms Sequencing

Published on Mon Sep 26, 2022

Question: I am confused about ICD-10-CM coding guideline IC.2.g. For example, a patient comes in with nausea and vomiting; she has cervical cancer and is awaiting treatment of chemo. She is given treatment for nausea in the emergency department (ED), and the final diagnoses are nausea, vomiting, and cervical cancer. In this situation, can the nausea and vomiting be coded as primary? Or, because it’s in chapter 18, does that mean it cannot? Does this guideline only apply to a sign and symptom that is related to the neoplasm?

Connecticut Subscriber

Answer: According to ICD-10-CM guideline I.C.2.l.4, if the complication (other than anemia) is “associated with a neoplasm … and the treatment is only for the complication,” then you are instructed to code the complication first “followed by the appropriate code for the neoplasm.”

This means you code the nausea and vomiting first using R11.2 (Nausea with vomiting, unspecified). Then, report the appropriate code for the associated neoplasm — in this case, C53.9 (Malignant neoplasm of cervix uteri, unspecified).

Remember: If your provider determines the cause of the patient’s nausea and vomiting is the result of the patient’s reaction to the chemotherapy, and not a result of the cancer, then your coding for the scenario will change. In this case, code the nature of the adverse effect R11.2, followed by the code for the adverse effect of the drug— T45.1X5- (Adverse effect antineoplastic drugs) and C53.9 if the underlying disease was also addressed as part of the visit assessment and plan.