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?


Comments

  • Still looking for some input on this.... Bueller?
  • Will take a closer look at this soon but I am going to paste a Q&A from Coding Clinic that an individual submitted.

    Question: Can both pancytopenia and neutropenic fever be coded when a patient has both? Coding only neutropenic fever fails to capture complexity/severity, but hard to argue that conditions are unrelated and bypass the excludes 1.

    Response: This letter is in response to your request for assistance coding pancytopenia due to acute myeloid leukemia with neutropenic fever due to chemotherapy.

    Assign codes D63.0, Anemia in neoplastic disease, D69.59, Other secondary thrombocytopenia, and D70.1, Agranulocytosis secondary to cancer chemotherapy, to report the separate components of pancytopenia, since the Excludes 1 note at category D61, Other aplastic anemia and other bone marrow failure syndromes, does not allow the reporting of code D61.818, Other pancytopenia, with category D70, Neutropenia, codes.

    Assign code R50.81, Fever presenting with conditions classified elsewhere, to separately report the fever. Code T45.1x5-, Adverse effect of antineoplastic and immunosuppressive drugs, is assigned for the adverse effect of the chemotherapy.

    Please see a similar example in Coding Clinic, Fourth Quarter 2014, pages 22-23.


    In your specific example, would you not code what was POA? I need to look at it further to give you a better response..Heme-onc gives me headaches!

    Jeff

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