Radiology Coding Alert

Question: A patient had an outpatient chest x-ray because he complained of weakness and has chronic myelogenous leukemia. The report documented no acute disease, but it noted a diaphragmatic hernia. Which ICD-9 codes should I report?

Washington Subscriber

Answer: You should report the weakness with 780.79 (Other malaise and fatigue) and the leukemia with chronic code 205.10 (Myeloid leukemia; chronic; without mention of remission).

The hernia 553.3 (Diaphragmatic hernia) is an incidental finding and doesn't relate to the reasons for the test, so you don't need to report it. Adding a secondary diagnosis is technically OK, though.

The rule: ICD-9 official guidelines state, "Code all documented conditions that coexist at the time of the encounter/visit, and require or affect patient care treatment or management."

The guidelines also state, "For patients receiving diagnostic services only during an encounter/visit, sequence first the diagnosis, condition, problem, or other reason for encounter/visit shown in the medical record to be chiefly responsible for the outpatient services provided during the encounter/visit. Codes for other diagnoses (e.g., chronic conditions) may be sequenced as additional diagnoses."

Resource: You can find the guidelines online at http://www.cdc.gov/nchs/datawh/ftpserv/ftpICD9/icdguide07.pdf.

Note: Chronic myeloid leukemia will get an ICD-9 update for 2009, with these fifth digit options:

• 0 -- without mention of having achieved remission

• 1 -- in remission

• 2 -- in relapse.

You can find the 2009 code list at http://www.cdc.gov/nchs/datawh/ftpserv/ftpICD9/ftpICD9.htm.