Consider Cause in This Cancer Anxiety Coding Conundrum
Question: Our providers often address the patient’s anxiety related to their new cancer diagnosis. Would you use F43.22 or F06.4 for this? AAPC Forum Participant Answer: The difference between F43.22 (Adjustment disorder with anxiety) and F06.4 (Anxiety disorder due to known physiological condition) lies in the etiology of the anxiety. Some physiological conditions, such as neurological disorders like Parkinson’s disease or endocrine disorders like hyperthyroidism or diabetes, can trigger psychological symptoms such as anxiety and depression. So, too, can substance use and withdrawal, and hormonal changes caused by pregnancy and menopause. And while anxiety is not generally acknowledged as a symptom of cancer, certain chemotherapy drugs — taxanes, paclitaxel, and doxorubicin particularly — and some hormone therapies, also list anxiety as a side effect. All of these anxiety responses to underlying conditions can be coded to F06.4. Code F43.22, however, should be used for a patient whose anxiety is a psychological response to the cancer diagnosis. The code is generally assigned when a patient has a disproportionate behavioral or emotional reaction to a life-changing event, such as a divorce, job loss, or news of a medical condition, and that response takes the form of anxiety. This would make F43.22 the most likely choice for the scenario you describe. However, you would be wise to query your providers about the causes for the patient’s anxiety before committing to one or another of the codes in the medical record. Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
