Oncology & Hematology Coding Alert

Question: What diagnosis codes would you use on this clinic follow-up visit? Patient has multiple myeloma and has developed grade-1 peripheral sensory neuropathy, secondary to Velcade therapy.

Codify Member

Answer: The documentation doesn't include information on remission, so you should report the multiple myeloma using 203.00 (Multiple myeloma, without mention of having achieved remission).

Because the oncologist links the neuropathy to Velcade therapy, you should report 357.6 (Polyneuropathy due to drugs). This code includes an instruction to "Use additional E code to identify drug." The appropriate E code is E933.1 (Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use).

The first-listed diagnosis should represent the main reason for the encounter.

Remember: You should report only those diagnoses confirmed by the physician. In some cases, the physician may document that neuropathy due to Velcade is probable or suspected. The physician should be queried to clarify whether this was a clinical judgment making the diagnosis of peripheral sensory neuropathy caused by Velcade therapy or whether this is a rule out situation where the condition is still only suspected. Unless the diagnosis is confirmed and supported in the provider's documentation, you should report the signs and symptoms. Section IV.I of the ICD-9-CM Official Guidelines for Coding and Reporting states that for outpatient claims, "Do not code diagnoses documented as 'probable,' 'suspected,' 'questionable,' 'rule out,' or 'working diagnosis' or other similar terms indicating uncertainty. Rather, code the condition(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for the visit."

ICD-10-CM: Under ICD-10-CM, 203.00 crosses over to C90.00 (Multiple myeloma not having achieved remission). Code 357.6 also has a simple crosswalk to G62.0 (Drug-induced polyneuropathy). To complete the report of the adverse effect, you'll find two codes similar to E933.1:

• T45.1X5A, Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter
• T45.1X5S, Adverse effect of antineoplastic and immunosuppressive drugs, sequela.