Oncology & Hematology Coding Alert

Question: We had a patient present with dehydration following therapy on a previous day for acute myelogenous leukemia, not in remission. Which diagnosis code should I report for the dehydration? Also, should I report the dehydration diagnosis first, or should I start with the neoplasm?

Nevada Subscriber

Answer: When you treat only the patient's dehydration and use intravenous hydration, you need to report the dehydration diagnosis first, followed by the malignancy.

How to code it: In your case, report the dehydration first, using the appropriate code -- for example, 276.51 (Volume depletion; dehydration).

You-ll follow this by reporting the patient's leukemia, using 205.00 (Myeloid leukemia; acute; without mention of remission).

Look out: If the patient presents for therapy and then develops dehydration due to complications while still in the office, report the V code for the therapy first -- V58.11 (Encounter for antineoplastic chemotherapy), for example -- followed by the code for the neoplasm and the code(s) for any complications the patient may be experiencing, such as 787.01 (Nausea with vomiting) and dehydration code 276.51.

For more information: You can find detailed information on coding for this condition in "Chapter 2: Neoplasms" of the ICD-9 Official Guidelines on the CDC Web site at http://www.cdc.gov/nchs/datawh/ftpserv/ftpICD9/icdguide07.pdf.