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).