Part B Insider (Multispecialty) Coding Alert

Find out why you must pay attention to the chronic condition

New anemia coding guidelines have been in effect for three months now. Here's the scoop on correctly coding anemia as primary and secondary diagnoses.

You should report 285.22 (Anemia in neoplastic disease) as the principal diagnosis when a patient presents with anemia associated with a malignancy and is only treated for the anemia. Report the malignancy as a secondary diagnosis, according to "Chapter 2: Neoplasms (140-239)" of the ICD-9-CM Official Guidelines for Coding and Reporting.

Reason: When you report 285.22 (or any code from the 285 subcategory), you must code for the chronic condition causing the anemia.

Case in point: An ovarian cancer patient presents with anemia due to intratumor bleeding. The oncologist treats her only for the anemia at this encounter.

Do this: Report the anemia as your principal diagnosis with 285.22. Then report the appropriate malignancy code, such as 183.0 (Malignant neoplasm of ovary), says Michael Berman, MD, FACOG, FACS, professor of gynecologic oncology at the University of California, Irvine. You may also report the anemia diagnosis as a secondary code if anemia treatment is a portion of the encounter, but not the primary reason for it.

Another example: A patient presents for chemotherapy to treat his stomach cancer, which is present at contiguous sites. Blood loss related to the cancer has resulted in anemia, and the oncologist treats this at the same encounter.

Do this: The primary reason for the encounter is chemotherapy, so report V58.11 (Encounter for antineoplastic chemotherapy). Then report the anemia (285.22) and the malignancy (151.8, Malignant neoplasm of stomach; other specified sites of stomach).

Key: These guidelines specify that you should use 285.22 for anemia that is due to the malignancy, not for anemia due to antineoplastic chemotherapy drugs, which is an adverse effect.