by Michael Alan Meyer, DO, CCS, CPC, CPCI, AHIMA ICD-10-CM/PCS Trainer and Ambassador
This marks our 9th week in this ICD-10-CM/PCS article series, and this week we will code our 3rd case! For this week’s case, let’s add Chapter 3, Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism to last week’s Chapter 2, Neoplasm... and mix it up a little! Click here for the case ANSWER
for last week.
Chapter 3: Diseases of the blood and blood-forming organs
There are no official guidelines in ICD-10-CM at this time regarding diseases of the blood and blood-forming organs. It is “Reserved for future guideline expansion”. However, there are differences in ICD-10-CM versus ICD-9-CM.
Anemia and Neoplasm
In ICD-9-CM, anemia due to antineoplastic chemotherapy and antineoplastic chemotherapy-induced anemia are considered synonymous. If a patient has a metastasis and is receiving chemotherapy and developed anemia we code report codes 199.1, Other malignant neoplasm of unspecified site and 285.22, Anemia in neoplastic disease. However, if the patient is being seen primarily to treat the anemia due to chemotherapy, then the anemia is coded as first and the cancer second, e.g., report 285.22 and 199.1.
Important Difference Between ICD-9 CM and ICD-10 CM Neoplasm and Anemia;
-D63.0 Anemia in neoplastic disease Code first neoplasm (C00-D49)
Excludes1: anemia due to antineoplastic chemotherapy (D64.81)
In ICD-10-CM, when an encounter is for the management of an anemia associated with malignancy, the malignancy is sequenced as the principal or first-listed diagnosis because of an instructional note and there is a guideline that addresses this situation.
The only time anemia would be coded first is if the patient is being treated primarily for anemia and it is not
associated or not
due to the neoplasm. ICD-10-CM tabular has an instructional notation under code D63.0, Anemia in neoplastic disease, to code first the neoplasm (C00 to D49).
Armed with the ICD-10-CM Official Coding Guidelines
, and the coding references, let’s code a neoplasm case! See Anemia and Neoplasm Case
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CDC, (2012) International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). National Center for Health Statistics. http://www.cdc.gov/nchs/icd/icd10cm.htm
CMS. (2012) Centers for Medicare & Medicaid Services (CMS) ICD-10 Website. https://www.cms.gov/Medicare/Coding/ICD10/index.html