November 08, 2010 | | Comments 2
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Major change to the coding guidelines regarding anemia secondary to malignancy

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.

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Jennifer Avery About the Author: Jennifer Avery, CCS, CPC, CPC-H, CPC-I, has extensive experience with coding for both physician and hospital services. Prior to joining HCPro, Inc., she worked for Health Partners Investments, LLC. a medical practice management company, as a Lead Coder where her duties included coder training, auditing and coding for all new specialty physicians and served as back-up coder for all other coders during vacations and back-log. Avery was also a Coding Consultant for Coding by the Numbers where her duties included coding for in-patient services on an as needed basis. Avery holds both Associates in Health Claims Management and Medical Assisting from Davenport University, Granger, Indiana. Avery currently serves as President of her local chapter of the American Academy of Professional Coders in Oklahoma City.

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  1. Hi,
    In Ireland we moved to ICD-10-AM (Australian Modification)in 2005. The method of coding of anemia in neoplastic disease in ICD-10-AM was new to coders in Ireland. In our ICD-10-AM classification of anaemia in neoplastic disease uses the dagger and asterisk convention. The neoplasm is the underlying condition and is sequenced before the aneamia which is the manifestation.
    Best of luck with the change to 10,
    Jacqui.

  2. There is a definite difference in anemia due to neoplasm and anemia due to chemotherepy and some neoplasms are more prone to cause anemia than others and if the patient is on chemotherapy, there is a good chance the anemia is due to a combination of the neoplasm and chemotherapy. Often times I see anemia due to chemotherapy documented, but actually the patient may have evidence of pancytopenia due to chemotherapy, and if the physician attests to this the coder codes 284.89 and E933.1. 284.89 is an MCC. Pancytopenia due to chemo is much more common than the physician documents, so coders beware

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