Hypercalcemia in Malignancy

sdemello@hhsc.org

Sequencing question… if a patient comes in for “hypercalcemia in malignancy” treated with NS 200ml/hr, serial monitoring, calcitonin, zometa given.   Metastatic breast CA, consult hospice, expired in hospital on day 2 of admission. 

Would you code the Cancer first or the hypercalcemia as a complication? 

Margaret_Foley

Hi.  There is a similar case in Coding Clinic which instructs to code the hypercalcemia as principal dx.  

See Coding Clinic, Hypercalcemia due to multiple myeloma Third Quarter 2012 Page: 16.  An 84-year-old female with known multiple myeloma  being readmitted for change in cognitive state. She was noted to be markedly hypercalcemic from the multiple myeloma. The patient was given intravenous hydration and supportive care. Aggressive treatment for the multiple myeloma was not pursued and the patient was transferred to hospice. How should this case be coded?

The thrust of treatment was directed at the hypercalcemia. Hypercalcemia is a complication of the multiple myeloma. Assign code 275.42, Hypercalcemia, as principal diagnosis. Assign codes 203.00, Multiple myeloma, without mention of having achieved remission, and V66.7, Encounter for palliative care, as additional diagnoses.

sdemello@hhsc.org

Thank you for your quick response.
Mahalo,
Shelly