Anemia associated with Neoplasm

ksammons

Hi Colleges, 

Need some advice on how to code this situation.  Patient has Kidney CA with mets to liver and lung.  Refused treatment for cancer and now is admitted with Anemia 2nd to Neoplasm.  I could not find any Coding Clinic that states you must code to the Principal Neoplasm vs the metastatic site.

Any advice?

Sincerely,

Kate Sammons, BS, RN, ACM, CCDS

CDI

NCH

847-618-4938

morris-jeff@CooperHealth.edu

Anemia associated with malignancy

When admission/encounter is for management of an anemia associated with the malignancy, and the treatment is only for anemia, the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis followed by the appropriate code for the anemia (such as code D63.0, Anemia in neoplastic disease).

This is taken directly from the ICD-10-CM Official Guidelines for Coding and Reporting FY 2019
Jeff

Sharme.Brodie@hcpro.com

Katy-I think what you are asking is does it make any difference, or is there any guidance out there that would dictate which cancer would be the principal diagnosis?  should it be the primary CA or could it be one of the secondary CA? depending on the answer and type of CA the final DRG assignment could be very different.  if there was no treatment directed at the CA and only the anemia was treated then we know we would follow the guideline that states "the CA would be sequenced first followed by the code for anemia r/t neoplastic disease.  but, I can't find anything that says the primary cancer or the metastatic cancer would be the principal diagnosis for this encounter  Understanding that the terms primary or secondary do not indicate the sequencing order for code assignment,  I took a close look at the guidelines and found something I found interesting- when reading the neoplasm guideline for coding a complication associated with a neoplasm (exception being anemia) it states "when treatment is for management of a complication associated with a neoplasm (ie dehydration) only, code the complication first followed by the code(s) for the neoplasm. but when you look at the guideline for Anemia associated with a neoplasm it reads "when the treatment is only for management of anemia associated with the malignancy, the appropriate code for the malignancy is sequenced as the principal or first listed diagnosis followed by code D63.o, Anemia in neoplastic disease. they did not put the (s) on the word code and gave no direction if more than one cancer was possibly the cause of the anemia. this may mean absolutely nothing. out of the cancers you mentioned none involve the bone marrow but you did mention Kidney CA that could be the cause of blood loss. Hopefully this information has not resulted in the waters being more muddy and, as always the best advice would be to query the provider.  

ksammons

Thank you for your advise.  Interesting topic for sure.

Sincerely,

Kate Sammons, BS, RN, ACM, CCDS