Oncology & Hematology Coding Alert

Plus: See what the guidelines say about your SIRS reports The latest CMS-approved ICD-9 Official Guidelines are out -- and we-ve broken down the oncology-related changes you need to know. 1. Set Yourself Up for SIRS Coding Success The most recent ICD-9 guidelines explain that -Systemic inflammatory response syndrome (SIRS) generally refers to the systemic response to infection, trauma/burns, or other insult (such as cancer) with symptoms including fever, tachycardia, tachypnea, and leukocytosis.- (See Section I.C.1.b and Section I.C.17.g.)

Note: Don't fall prey to the common mistake of confusing -sepsis- and -SIRS- diagnoses with infection, says James Kennedy, MD, CCS, vice president of MA Health Solutions Inc. in Nashville, Tenn. A patient cannot develop sepsis without first having SIRS, and SIRS may or may not result from infection.

Coding rules: The updated guidelines say, -The code for the underlying cause (such as infection or trauma) must be sequenced before the code from subcategory 995.9 Systemic inflammatory response syndrome (SIRS),- when the physician doesn't document subsequent infection. The physician must document either the term sepsis or SIRS to assign a code from subcategory 995.9.

Example: A patient develops SIRS due to cancer, and the physician documents SIRS without subsequent infection, then you should report:

1. the code identifying the cancer (such as 157.0, Malignant neoplasm of pancreas; head of pancreas) and then

2. the appropriate SIRS code, such as 995.90 (Systemic inflammatory response syndrome, unspecified), 995.93 (Systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction), or 995.94 (Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction).

For 995.94, you also need to report the code to specify the acute organ dysfunction, such as 584.5 (Acute renal failure; with lesion of tubular necrosis), in addition to reporting the noninfectious process. 2. Find New Code V86.x Fast The latest update includes a new, more user-friendly V code table with columns showing whether each code is first listed, first or additional, additional only, or non-specific diagnosis (page 68).

Previously you had to search through multiple lists to locate a specific V code, says Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, Ga.

Watch for: The new V code table lists V86.x (Estrogen receptor status), meant for use with breast malignant neoplasm codes 174.x (Malignant neoplasm of female breast) and 175.x (Malignant neoplasm of male breast), which say to -use additional code to identify estrogen receptor status.-

When you look up the new V codes in the ICD-9 manual, you-ll see a note to -Code first malignant neoplasm of breast (174.0-174.9, 175.0-175.9).-

Example: For a female patient with a malignant breast neoplasm and estrogen receptor positive status, you should report the neoplasm (174.x) and then the estrogen receptor status with V86.0 [...]