Proper ICD-10-CM coding of anemia requires the coder to know what is causing the condition. Let’s look at types of anemia, and medical coding and sequencing of the disease when it is caused by a malignancy or adverse effect.
Anemia Basics
Anemia is a disease of the blood that occurs when a patient’s red blood cells are reduced and there is a lack of oxygen delivery to cells and tissues. Symptoms include weakness and fatigue. The components of blood are red blood cells (erythrocytes), white blood cells (leukocytes), and platelets. Hemoglobin, an important component of the red blood cells, is comprised of a protein called globulin and a heme molecule, which binds to iron.
There are many types of anemia but the most common are:
- Iron deficiency anemia
- Vitamin B12 deficiency anemia
- Folic acid deficiency anemia
Anemia may be a causal effect of another disease, such as a malignancy, or an adverse effect of treatment such as radiotherapy, chemotherapy, or immunotherapy.
There are specific ICD-10-CM coding guidelines for proper code selection and sequencing of anemia caused by other diseases.
Anemia Associated with Malignancy
According to the 2018 ICD-10-CM Official Guidelines for Coding and Reporting, when the reason for the encounter is to manage anemia associated with a malignancy, and the treatment is only for anemia, the appropriate code for the malignancy is sequenced first, followed by the appropriate code for anemia. Example: A 47-year-old female patient with a diagnosis of lung cancer presents to her oncologist, reporting excessive fatigue and decreased tolerance to exercise. A lab test performed by the oncologist determines the patient has anemia due to the lung cancer. ICD-10-CM coding:
C34.90 Malignant neoplasm of unspecified part of unspecified bronchus or lung
D63.0 Anemia in neoplastic disease
Remember: When the reason for the encounter is to manage anemia caused by a malignancy, sequence the malignancy code first, followed by the anemia code.
Anemia Due to Chemotherapy, Immunotherapy, or Radiation Therapy
According to the 2018 ICD-10-CM Official Guidelines for Coding and Reporting, when the reason for the encounter is for management of anemia associated with the adverse effect of chemotherapy, immunotherapy, or radiation therapy, the anemia code is sequenced first, followed by the appropriate code for the neoplasm and the adverse effect code (T45.1X5 Adverse effect of antineoplastic and immune suppressive drugs)
The same guideline applies to management of radiotherapy (Y84.2 Radiological procedure and radiotherapy as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure)
Example: A 68-year-old male with prostate cancer receiving chemotherapy visits his oncologist to receive a Procrit® injection for anemia caused by the chemotherapy.
ICD-10-CM coding:
D64.81 Anemia due to antineoplastic chemotherapy
C61 Malignant neoplasm of prostate
T45.1X5A Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter Remember: When the reason for the encounter is to manage anemia for an adverse effect, sequence the anemia code first, the malignancy code second, and adverse effect code third.
To learn about complete blood count testing for red blood cells, read the article “Examine Testing for Complete Blood Counts without Platelets” in AAPC’s Knowledge Center.
Oby Egbunike, CPC, COC, CPC-I, CCS-P, is the director of professional coding at Lahey Health Care System, Burlington, Mass. She holds a Bachelor of Arts in Business Administration with a concentration in Health Information Management from Northeastern University Boston. Egbunike has over 10 years of experience in the healthcare areas of management, coding, billing, and revenue cycle. She is a member of the Burlington, Mass., local chapter.
Sequence Anemia in Order of Events was last modified: December 11th, 2021 by Guest Contributor
This week our focus is on the sequencing of the principal diagnosis (PDX) when patients present with anemia (Chapter 3 in ICD-10). Anemia is the most common disorder of the blood, and it affects about a quarter of the population in the world.
Here are a few examples:
- Patient is admitted with anemia due to chronic kidney disease (CKD) or end stage renal disease (ESRD). CKD/ESRD would be the appropriate PDX selection even when treatment is directed towards the anemia only. Per the instructional notes in ICD-10-CM, code first the underlying cause. The manifestation code would not be appropriate as the PDX.
- Patient is admitted with anemia due to underlying malignancy. The site of the malignancy would be the appropriate PDX selection even when treatment is directed towards the anemia only. Per the instructional notes in ICD-10-CM, code first the neoplasm. When reading the documentation in the record coders should look for documentation to see if this is anemia of the malignancy or if this is due to the treatment of the malignancy (surgical blood loss anemia or drug induced anemia). If not due to the malignancy but due to the treatment of the malignancy then anemia may be appropriate as the PDX.
- Patient is admitted with anemia and malignancy. The physician documents that the anemia is due to the anti-neoplastic drugs that the patient has been taking. In this case, the anemia due to antineoplastic chemotherapy would be sequenced as the PDX and not the malignancy (if the treatment is only directed at the anemia).
- Patient is admitted with anemia due to rheumatoid arthritis and lupus. Treatment is directed at correcting the anemia. The underlying chronic condition of rheumatoid or lupus would be the appropriate PDX selection. Per the instructional notes in ICD-10-CM, code first the underlying chronic condition.
Below are a few definitions of anemia and the types associated with chronic diseases/malignancy. Please keep in mind, this is a very small selection of types of anemia (there are over 400 types but can be divided into three groups…anemia caused by blood loss, anemia caused by decreased or faulty red blood cell production, and anemia caused by destruction of red blood cells).
Anemia—decrease in the number of RBCs or hemoglobin in the blood
Anemia of Chronic Disease (or of chronic inflammation)—This type of anemia is associated with many underlying chronic disorders including cancer, infections, autoimmune disease, inflammatory diseases, or kidney disease being the most common culprits.
Anemia due to Chemotherapy—very common side effect of use of chemotherapy drugs treating malignancy. Chemotherapy reduces the bone marrow’s ability to make red blood cells.
Aplastic Anemia—your marrow stops making new blood cells (red, white, and platelets). The bone marrow stops producing enough new blood cells. The patient is deficient of red blood cells, white blood cells and platelets. Not a single disease but a group of closely related disorders characterized by failure of the bone marrow to produce all three types of blood cells (red, white, and platelets). This is a very rare disorder and only affects about 1,000 people each year in the US.
References
ICD-10-CM Official Guidelines for Coding and Reporting FY 2019 Pages 31-34
ICD-10-CM/PCS Coding Clinic, Third Quarter Page: 4
ICD-10-CM/PCS Coding Clinic, Third Quarter Page: 17
ICD-10-CM and ICD-10-PCS Coding Handbook
October 27, 2008
Neoplasm Guidelines
For The Record
Vol. 20 No. 22 P. 28
The ICD-9-CM Official Guidelines for Coding and Reporting was updated effective October 1, 2008. The neoplasm guidelines, among others, were updated. Coders often have questions about the coding and proper sequencing of neoplasms, so below is a summary of the common neoplasm rules and guidelines.
Neoplasm Coding Guidelines
• Designate the malignancy as the principal diagnosis when the treatment is directed toward the malignancy. However, if a patient is admitted solely for the administration of chemotherapy, immunotherapy, or radiation therapy, assign a code from category V58 as the principal diagnosis and the malignancy as the secondary diagnosis.
• Designate the secondary site neoplasm as the principal diagnosis when the treatment is directed only toward the secondary (metastatic) neoplasm even though the primary site is still present. If the treatment is directed equally toward both the primary and secondary sites, assign the primary malignancy as the principal diagnosis (AHA ICD-9-CM Coding Handbook, Faye Brown, 2004, page 300).
• Sequence anemia as the principal diagnosis when the admission is for the management of anemia associated with the malignancy or the therapy and the treatment is only directed at the anemia. The anemia code assignment will depend on the specific type of anemia documented. Code 285.22, Anemia in neoplastic disease, is used for anemia due to malignancy. Do not use code 285.22 for anemia that is due to antineoplastic chemotherapy drugs.
• Sequence dehydration as the principal diagnosis when the admission is for the management of dehydration due to the malignancy or the therapy and only the dehydration is being treated.
• When the admission is for the treatment of a complication resulting from a surgical procedure, sequence the complication as the principal diagnosis if treatment is directed at resolving the complication.
• When the primary malignancy has been previously excised or eradicated from its site and there is no adjunct treatment directed at that site and no evidence of any remaining malignancy at the primary site, use the appropriate code from category V10, Personal history of malignant neoplasm, to indicate the former site of the primary malignancy. Documentation of the extension, invasion, or metastasis to another site is coded as a secondary malignant neoplasm to that site. The metastatic site may be sequenced as the principal diagnosis if treatment is directed toward the metastatic site.
• Sequence the malignancy as the principal diagnosis when the patient is admitted for the surgical removal of a malignancy followed by chemotherapy or radiation therapy. If the patient is admitted solely for the purpose of receiving chemotherapy, immunotherapy, or radiotherapy, sequence code V58.11 (Admit for chemotherapy), V58.12 (Admit for immunotherapy), or V58.0 (Admit for radiotherapy) as the principal diagnosis.
• Sequence the malignancy (either the primary or secondary) as the principal diagnosis if the patient is admitted to determine the extent of the malignancy (staging) or for a procedure such as thoracentesis or paracentesis even though chemotherapy or radiation therapy is administered.
• Sequence the malignancy as the principal diagnosis when the patient is admitted with signs and symptoms related to the malignancy.
• A malignant neoplasm of a transplanted organ is assigned to a code from subcategory 996.8, Complications of a transplanted organ, and code 199.2, Malignant neoplasm associated with transplanted organ. Also, assign a code for the specific malignancy.
Other Neoplasm Coding Directives
• If a patient is admitted with a nonneoplastic condition for chemotherapy or immunotherapy, assign the condition as the principal diagnosis. Do not assign code V58.11 or V58.12. For example, a patient is admitted for chemotherapy to treat macroglobulinemia. Assign code 273.3; do not assign code V58.11.
• If the patient is admitted for a radioactive implant, assign the malignancy as the principal diagnosis; do not assign code V58.0.
• Assign a code for the malignancy if a patient is receiving treatment (eg, chemotherapy) for a malignancy that has already been excised. Do not assign a code from category V10, Personal history of malignant neoplasm, because the patient would not still be under treatment if the malignancy were actually a history of malignancy.
Coding and sequencing for neoplasms are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.
— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 4,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.