While attending an American Health Information Management Association ICD-10 course, I was surprised to learn that there is a huge change to the coding guidelines regarding neoplasms. Currently in ICD-9-CM, if a patient is admitted for complications due to the malignancy, the complication is the principal diagnosis. We even have a code that specifically addresses anemia in neoplastic disease, and now we have one that addresses anemia associated with chemotherapy. Assignment for both follow the same guideline—that the complication (i.e., the anemia) is the principal diagnosis.
However, this rule appears to have changed in ICD-10-CM.
If a patient is admitted for anemia associated with malignancy and the treatment is only for the anemia, the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis followed by code D63.0 (anemia in neoplastic disease). This is a huge change that we will have to get used to when transitioning from ICD-9 to ICD-10.
Even more interesting is the fact that the rule regarding anemia associated with chemotherapy, immunotherapy, and radiation therapy will follow the guidelines associated with “adverse effects.” Therefore, the appropriate adverse effect code should be sequenced first, followed by the appropriate code for the anemia and neoplasm.
Coders should keep this in mind and begin working with their physicians now so that they can identify the appropriate guideline to apply when coding for anemia. To ensure coders assign the appropriate code, it will be important that physician documentation identifies whether the anemia is associated with the neoplasm or an adverse effect of the treatment associated with the malignancy.