285.3 vs. 284.89: Documentation of 'Aplastic' Can Aid Steer Your Coding

Determine which condition is more expected to be caused by chemotherapy.

Patients suffering from cancer might develop anemia from a number of causes. Here is the expert guidance to help you decide the source and for a compliant coding.

With this expert insight, go deeper into proper anemia coding, looking at codes for anemia caused by treatment and at how guidelines are likely to change when shifting from ICD-9 to ICD-10 becomes compulsory in 2013.

Double Check Documentation Before You Assign 284.89

When documentation demonstrates that antineoplasticchemotherapy resulted in patient's anemia, you are required to consider two codes:

285.3, i.e. Antineoplastic chemotherapy encouraged anemia

284.89, i.e. Additional specified aplastic anemias, because of drugs.

The chief difference between the two is that 284.89 references "aplastic" anemia.

Antineoplastic chemotherapy induced anemia is not typically an aplastic process. The anemia is expected to be short term, but it might vary from mild to severe. So 285.3 may be applicable to your patient's claims more frequently than 284.89, however you must allow documentation to have an impact on your choice. Prior to aasigning 284.89, you must ensure that the documentation demonstrates that the anemia is aplastic and is because of drugs.

Helpful: Referring to the ICD-9 notes for information is an important aspect of appropriate coding.

For instance, an "excludes" note that comes under 285.3 informs you instead to go ahead and use 284.89 for "aplastic anemia because of antineoplastic chemotherapy.

Bonus tip: As 285.3 defines chemotherapy as the reason of the anemia, you are not required to add E933.1 (Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use) to your claim. Code 285.3 adequately explains that the situation is an adverse result of chemotherapy. In case your practice goes for the usage of the E code for internal data collection, that's indeed a valid option.

Expect a Shake-Up When ICD-10 Begins

In case a patient presents for treatment of anemia because of a neoplasm, paying attention to such diagnosis coding guidelines will become even more significant as you get ready to use Supercoder ICD-10 in place of ICD-9. Particularly, the ICD-10 2011 guidelines for anemia coding vary from those you know for ICD-9.

Example 1: A patient comes for treatment of just anemia. The physician documents that the patient's neoplasm initiated the anemia to grow.

Under ICD-9 2011 guidelines, your first-listed code must report the anemia (285.22). The proper malignancy code(s) should follow (ICD-9, Section I.C.2.c.1).

In case you were instead applying ICD-10 2011 guidelines, you are supposed to report the malignancy code first and after that the anemia code, D63.0 (Anemia in neoplastic disease) (ICD-10, Section I.C.2.c.1).

Are You Well Acquainted with the New ICD-9 Codes?

October 1 brought many changes and we hope that you have made yourself well acquainted with the latest ICD-9 changes . Pediatric diagnosis code changes aren't plentiful this year, but there are still quite a few that could result in denied claims if you don't update your forms.

The quiz below is on the new, revised, and deleted codes and will certainly help you decide whether you're on the right track or if you require reviewing your ICD-9 coding skills.

Pin down Flu Codes

Question 1: A 12-year-old patient come with influenza because of recognized novel influenza A virus along with pneumonia. Which code are you supposed to report?

A. 487.0

B. 488.01

C. 488.81

D. 488.82

Answer: C. From Oct. 1, you'll have advantage from novel code 488.81 (Influenza due to identified novel influenza A virus with pneumonia) to define this condition. Earlier, you most probably would have used 487.0 (Influenza with pneumonia), however that code didn't identify the nature of influenza A.

The ICD-9 Committee has reviewed the influenza codes many years in a row now, which may make coding these particular conditions a bit challenging, however the most significant element to remember while reporting these illnesses is to study the documentation for validation of the kind of influenza that the patient has. When uncertain, check any lab reports or inquire the physician to explain.

Remember: You'll also see revised diagnosis code descriptors for the H1N1 codes, as following:

488.11 - i.e. Influenza because of identified 2009 H1N1 influenza virus along with pneumonia

488.12 - i.e. Influenza because of identified 2009 H1N1 influenza virus along with further respiratory manifestations

488.19 -- i.e. Influenza because of identified 2009 H1N1 influenza virus along with further manifestations

Curb TB Test Confusion

Question 2: A patient comes for a tuberculosis skin test. The consequences come back presentating that the patient went through a reaction to the test, though does not have active tuberculosis. Which code are you supposed to report?

A. 795.51

B. 795.5

C. 795.4

D. 795.52

Answer: A. From Oct. 1, the ICD-9 code listing will remove nonspecific code 795.5 (Nonspecific reaction to tuberculin skin test without active tuberculosis) and substitute it with two more definite codes, one of which is the correct answer to the above question, 795.51 (Nonspecific reaction to tuberculin skin test without active tuberculosis).

ICD-9 will also present code 795.52 (Nonspecific reaction to cell mediated immunity measurement of gamma interferon antigen response without active tuberculosis) to distinct out the former 795.5 category.

Migrate To 5010 form before Hopping into ICD-10 Bandwagon

As ICD-10 goes into effect on October 1, 2013, you will need to start your transition with a piece of health insurance reform legislation called 'Version 5010'. This form lays out the technical electronic transaction standards mandated for Health Insurance Portability & Accountability Act of 1996 (HIPAA) transactions and includes requirements for transmission of claims and payment data using the soon-to-go-into effect ICD-10 code set. This form will affect almost everyone involved in healthcare transactions.

Why 5010 form?

The present system version 4010/4010A1 lacks functionality for some transactions; more importantly, it does not accommodate the ICD-10 code set. This system will therefore be replaced by version 5010 for eligibility enquiries and remittance advices. The new version will take up various problems and complexities found in the earlier version. Additionally, the just-in form also comes with other diagnosis reporting advantages.

When: Although Centers for Medicare & Medicaid (CMS) has started accepting 5010 forms from January 1, 2011, the deadline for you to start using this form is January 1, 2012.

Need of the hour: However, it's being seen that too many billers and providers are taking this deadline casually. What happens in case you fail to submit the 5010 form by the set deadline? When that happens, you will no longer be able to submit electronic transactions to Medicare; you will also receive delayed or reduced payments, audits will frequent you and your practice and there are chances your relationship with your vendors and payers will turn sour. What's more, your practice is also likely to witness a dip in productivity in case of a failure to use this form.

Communicate with your vendors immediately: So if you want to switch to 5010 format successfully, you need to communicate with your vendors first.

Four additional ways to help EPs duck E-prescribing Penalty

According to a new proposal, EPs would be eligible to request for hardship exemption till October 1, 2011.

Next year, you may be subject to a one percent payment adjustment on your Part B payments if you don't get onboard the e-prescribing bandwagon in 2011. This payment adjustment will keep going up with each year - 1.5 percent in 2013 and 2 percent in 2014.

Exemption criteria too limited? Although the agency had laid down that practitioners could evade the penalty, practitioners were not too happy as they found the exemptions were too limited and did not include realistic situations. Taking this into consideration, the agency has come up with four more ways eligible professionals can avoid the penalty:

New proposal aims to exempt those who have just got their technology in place or are getting it in position

The agency's new proposal will offer exemption to those practitioners who have just got their technology in place or are in the process of doing so as they may not have e-prescribed ten times within the first half of the current year.

Physicians who prescribe narcotics or medications that cannot be transmitted electronically will get a breather

Secondly, there are many physicians who prescribe narcotics. Practices that prescribe large quantities of these drugs may find that they cannot take the electronic way even if they wanted to participate in it.

Patients who do not need to prescribe medications for several reasons are likely to get hardship exemption

Some practitioners seem like they're eligible for the penalty because they carry out enough visits; however that may not be the reality because chances are they may not prescribe medications for several reasons. Keeping this in mind, the agency is proposing that the physicians and other EPs be allowed to send a request for a hardship exemption.

Not enough opportunities to report the e-prescribing measure owing to limitations in the measure's denominator

Sometimes it may so happen that a surgeon may prescribe electronically but the prescriptions may not be associated with the kind of visits that the e-prescribing measure's denominators include. The new proposal comes to rescue of these physician.