Make Your Way Through the Malaise of This Coding Muddle
Question: A patient on a course of chemotherapy for lymphoma came in complaining of fatigue. In this situation, do I follow ICD-10-CM guideline I.C.2.g., which tells me I cannot use a signs and symptoms code from Chapter 18 as a principal or first-listed diagnosis; or do I follow guideline I.C.2.l.4, which says if the complication is being treated, unless the complication is anemia, you code the complication first followed by the code for the cancer? Texas Subscriber Answer: On the surface, both guidelines seem to contradict each other, as you say. Guideline I.C.2.g tells you that “symptoms, signs, and ill-defined conditions listed in Chapter 18 characteristic of, or associated with, an existing primary or secondary site malignancy cannot be used to replace the malignancy as principal or first-listed diagnosis,” while guideline I.C.2.l.4 says, “if the complication (other than anemia) is “associated with a neoplasm … and the treatment is only for the complication,” then you are instructed to code the complication first “followed by the appropriate code for the neoplasm.” Complicating this, your scenario does not specify whether the provider has determined if the fatigue is the result of the lymphoma itself or the chemotherapy the patient is receiving for the condition. Fortunately, in the first of these possible scenarios, if the provider determines the fatigue is due to the lymphoma, the coding will follow the Code first instruction for R53.0 (Neoplastic (malignant) related fatigue), which tells you you’ll code first the associated neoplasm — in this case, likely a code from C85.9- (Non-Hodgkin lymphoma, unspecified). Neither guideline applies to the second possible scenario, however, as the fatigue in this case is due to the chemotherapy. So, you’ll follow the overarching ICD-10-CM guideline to code the condition being treated at the encounter, which is the fatigue. Here, you’ll use a different fatigue code, such as R53.83 (Other fatigue) followed by the code for the adverse effect of the drug — T45.1X5- (Adverse effect of antineoplastic and immunosuppressive drugs). You might also add the C85.9- diagnosis if the underlying condition was also addressed as part of the visit assessment and plan. Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
