chemotherapy induced pancytopenia

I had a pt that was admitted for Neutropenic Fever. The ED physician also stated the patient had "pancytopenia due to chemotherapy". Since this was not carried forward in the record, I queried the attending and he also gave me pancytopenia due to chemotherapy. The coders would not take this as an MCC. Per my Coding leader, she states "Aplastic anemia due to chemotherapy is an MCC. Pancytopenia due to Chemo is antineoplastic chemotherapy induced pancytopenia with an adverse effect code unfortunately not an MCC just a CC." Am I incorrect about chemo-iduced pancytopenia being an MCC? If so, when did this change?? I appreciate any feedback!

Julie Cruz RN, CDS


  • I haven't done cdi for a few months but I think because of the principal diagnosis if they were here for GI bleed it would be a MCC, but I think it' sort of integral to the neutropenic fever. this is just off the top of my head but you could investigate this.
  • edited May 2016
    It depends on your PDX if it is a MCC. If you are using neutropenic fever as your PDX then the pancytopenia due to chemo IS NOT a MCC. I know, it stinks :(

    Dawn M. Vitalone, RN, CCDS
    Clinical Documentation Improvement Specialist
    Community Hospital

  • edited May 2016

    284.11 is an MCC in most circumstances depending on your principal diagnosis. However, if your neutropenic fever is your principal, pancytopenia due to chemo is not a MCC.

    See coding clinic below for Drug-induced panyctopenia

    Drug-induced pancytopenia

    Coding Clinic, Fourth Quarter 2011 Pages: 91-92 Effective with discharges: October 1, 2011

    Effective October 1, 2011 code 284.1 has been expanded to uniquely identify antineoplastic chemotherapy induced pancytopenia (284.11), other drug induced pancytopenia (284.12) and other pancytopenia (284.19). Previously, code 284.89, Other specified aplastic anemia, was assigned for chemotherapy induced pancytopenia. This caused a lack of specificity in coding and reporting both chemotherapy induced pancytopenia and other drug induced pancytopenia.

    Pancytopenia is an abnormally low level of all blood cells produced by the bone marrow. This includes a low level of red blood cells (RBCs), white blood cells (WBCs) and platelets. Antineoplastic chemotherapy induced pancytopenia is due to bone marrow suppression caused by the administration of cancer drugs. Bone marrow suppression (a decreased ability of the bone marrow to manufacture blood cells) is a common side effect of chemotherapy.

    284 Aplastic anemia and other bone marrow failure


    284.1 Pancytopenia

    Excludes: pancytopenia (due to) (with):

    Deletedrug induced (284.89)

    New code284.11 Antineoplastic chemotherapy

    induced pancytopenia

    Excludes: aplastic anemia due to

    antineoplastic chemotherapy


    New code284.12 Other drug-induced pancytopenia

    Excludes: aplastic anemia due to drugs


    New code284.19 Other pancytopenia

    Dorie Douthit RHIT,CCS
    Clinical Documentation Specialist/HIM
    St. Mary’s Healthcare System
    1230 Baxter Street
    Athens, GA 30606
  • edited May 2016
    Lightbulb moment! It has to do with my PDX! I thank you folks so very much!! So glad we have this site!! TGIF!

    Julie Cruz RN, CDS

    Clinical Documentation Specialist
    St. Joseph Health
    2700 Dolbeer St
    Eureka, CA 95501
    wk: 707-445-8121 ext. 7550
    cell: 707-267-0973

  • edited May 2016
    Thank you all for the original question and subsequent comments. Pancytopenia d/t chemo is a query I write whenever I can because I review the oncology unit. We did not get new code books last year for 2013 (avail Oct 2012) due to ICD 10 coming out. I am not yet in habit of checking the codebook online. Code 284.11 has never had any CC exclusions. So, looked up the 2013 ICD 9 codebook online and, sure enough, there are exclusions! Amazing. So thankful from our CDI Talk networking to realize we need to work on some other strategies.

    I did discuss this issue with our coding auditor, inpatient coder for over 30 years. She says that in the case of neutropenic fever, if an infection can be identified (which she said many times an infection cannot be identified), the infection would be sequenced first as principal dx so the 284.11 pancytopenia d/t chemo would be a MCC. I did check this out with 288.00 Neutropenic Fever and 284.11 coded. When I sequenced UTI or sepsis or infection d/t PICC line, the 284.11 was an MCC. So looks like a query would be in order to make sure the infection/cause of the neutropenic fever be documented.

    I am realizing that I need to be more diligent to keep my basic foundation skills/strategies in order to keep up on all changes, especially each October. You get so busy trying to get reviews done, but a big part of our role as CDS' is to identify new strategies needed because of the changes.

    Thanks again to CDI Talk contributors!

    Karen Maritano, RN
    Clinical Documentation Specialist
    Legacy Health

  • edited May 2016
    Just realized everyone may not understand CC Exclusions listed under applicable individual codes. So if any of the diagnosis codes listed in CC Exclusions are the principal diagnosis, the code (in our case 284.11 pancytopenia d/t chemo) is not a CC/MCC. Please check these out. There are many other principal diagnoses where 284.11 is not an MCC.

    Karen Maritano, RN
    Clinical Documentation Specialist
    Legacy Health

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