Pancytopenia/ Neutropenic fever
I have a case that I am a little confused on and would like some guidance. Patient presented with a stroke, was also pancytopenic due to chemo. The reason for admission was the CVA, pancytopenia due to chemo as an MCC.
Later in the hospital stay, the patient developed a fever which they called “neutropenic fever”. Do we use the advice of this coding clinic and code agranulocytosis, anemia, and thrombocytopenia and not the pancytopenia?Question: A patient with anemia and thrombocytopenia is admitted with fever and neutropenia. The provider documented that the neutropenia and anemia are secondary to chemotherapy for medulloblastoma with spinal metastasis. Since pancytopenia includes anemia, neutropenia and thrombocytopenia, is it appropriate to assign a code for pancytopenia when the neutropenia is secondary to chemotherapy? Answer: Assign code D70.1, Agranulocytosis secondary to cancer chemotherapy, as the principal diagnosis. Codes R50.81, Fever with conditions classified elsewhere, T45.1X5A, Adverse effect of antineoplastic and immunosuppressive drug, Initial encounter, D64.81, Anemia due to antineoplastic chemotherapy, D69.59, Other secondary thrombocytopenia, should be assigned as additional diagnoses. Patients may present with both pancytopenia and neutropenia with fever. They are clinically different processes. The pancytopenia code alone does not convey the complete clinical picture. However, the excludes1 note at category D61, Other aplastic anemias and other bone marrow failure syndromes, prohibits assigning code D70.1 along with a pancytopenia code in this category. The National Center for Health Statistics (NCHS) has agreed to address the issue of the excludes1 at category D61 at a future ICD-10-CM Coordination and Maintenance Committee (C&M) meeting.
If a patient has pancytopenia due to chemo and at any time develops a fever (neutropenic fever) we don’t code the pancytopenia? Doesn’t make a lot of sense to me when it is not the reason for admission. You lose your MCC if the patient develops a neutropenic fever during the stay?