Oncology & Hematology Coding Alert

You can look forward to something new from 2009 ICD-9 for complication category 999.

The first change comes with the addition of two fifth-digit options for 999.8 (Complications of medical care, not elsewhere classified; other transfusion reaction).

As of Oct. 1, instead of reporting 999.8 for transfusion complications, you-ll report new code 999.81 (Extravasation of vesicant chemotherapy).

The other new code for this group is 999.82 (Extravasation of other vesicant agent).

What it is: Intravenous chemotherapy drugs that can cause a chemical burn if they inadvertently go into the tissue are called vesicants, says Lisa Schulmeister, RN, MN, APRN-BC, OCN, FAAN, of TopoTarget USA Inc. in her coding request presentation to the ICD-9-CM Coordination and Maintenance Committee.

The burns may occur if the IV device dislodges, leaks or breaks, Schulmeister says.

Why the change: The complication isn't truly a device complication under 996.1 (Mechanical complication of other vascular device, implant or graft) or a vascular complication (999.2, Other vascular complications), Schulmeister says.

Watch out: Take special note of the 999.8x location because you might not expect to see this particular complication in this category -- particularly if you were used to reporting 996.1 or 999.9 (Other and unspecified complications of medical care, not elsewhere classified) previously -- as noted in the ICD-9-CM Coordination and Maintenance Committee Meeting.

Resources: You can download the minutes from the meeting at http://www.cdc.gov/nchs/data/icd9/Sep06CMSum.pdf, where you can also find the Schulmeister presentation at http://www.cdc.gov/nchs/ppt/icd9/att5_Schulmeister_Sep07.ppt.