Oncology & Hematology Coding Alert

Question: If the patient has lung cancer and anemia, can we assume the anemia is due to the cancer and code it that way if the documentation does not say it is?

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Answer: No, you cannot assume linkage when a patient has both cancer and anemia. Instead, your oncologist needs to specifically document whether the anemia is due to the neoplasm or the chemotherapy. Otherwise, you will code the anemia as D64.9 (Anemia, unspecified).

If the provider does document there is a link between the cancer and the anemia, you’ll code D63.0 (Anemia in neoplastic disease) for the anemia. You’ll also have to code the malignancy — in this case with an appropriate code from C34.- (Malignant neoplasm of bronchus and lung) — first “when admission/encounter is for management of an anemia associated with the malignancy, and the treatment is only for anemia” per ICD-10-CM guideline I.C.2.c.1.

In situations where the provider documents the patient’s anemia is due to therapy, you have several choices. Again, assuming the encounter is for anemia management, this time you’ll begin with the anemia code — in this case, D64.81 (Anemia due to antineoplastic chemotherapy) — followed by the appropriate code from C34.-.

You’ll then use T45.1X5- (Adverse effect of antineoplastic and immunosuppressive drugs) if the anemia is an adverse effect of the administration of chemotherapy or immunotherapy, or Y84.2 (Radiological procedure and radiotherapy as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure) if the encounter is for management of an anemia associated with an adverse effect of radiotherapy. When using T45.1X5-, you will also need to add the appropriate 7th character — A (initial encounter), D (subsequent encounter), or S (sequela) — to indicate the episode of patient care.