Oncology & Hematology Coding Alert

Question: A patient with cancer reported to our oncologist complaining of fatigue. The provider documented the fatigue is due to anemia, which in turn is due to the chemotherapy the patient is receiving for the cancer. How should I code this?

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Answer: If the provider has determined the patient’s fatigue is due to the chemotherapy, you will have to use four codes: one for the anemia caused by the chemotherapy, one for the adverse effect of the chemotherapy, one for the cancer, and one for the fatigue.

Coding for this scenario will then look like this:

• Report D64.81 (Anemia due to antineoplastic chemotherapy) for the anemia.
• Report T45.1X5- (Adverse effect of antineoplastic and immunosuppressive drugs) for the cause of the anemia, which is the chemotherapy treatment. Per the T45.- category instructions, you’ll also add a 7th character A (initial encounter), D (subsequent encounter), or S (sequela), depending on the stage of patient care.
• Report the appropriate code for the cancer or condition being treated by the chemotherapy.
• Report R53.83 (Other fatigue) for the fatigue.

Why? In a similar coding scenario, AHA ICD-10-CM Coding Clinic 3rd Quarter 2021 tells you that D64.81 would be the principal diagnosis in this case. Additionally, R53.83 would be preferred over R53.0 (Neoplastic (malignant) related fatigue) as the anemia is specified as being due to the chemotherapy.

And remember, should the patient’s condition be coded to another code from D46.- (Myelodysplastic syndromes) or a code from C92.0- (Acute myeloblastic leukemia), you should ignore the Excludes1 note for the D64.- code block, which tells you D64.81 cannot be coded with a code from D64.- or C92.0-. That’s because both D64.81 and the condition code are required to capture both anemia due to chemotherapy and the cancer the chemotherapy is treating. These are separate, unrelated conditions; the anemia is being caused by the chemotherapy not the condition the chemotherapy is treating, and thus they are an exception to the Excludes1 note.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC