Oncology & Hematology Coding Alert

Question: Which codes should I report when a patient with pernicious anemia presents for a vitamin B12 injection?

Florida Subscriber

Answer: For the diagnosis, you should report 281.0 (Pernicious anemia).

Vitamin B12 deficiency causes this form of megaloblastic anemia, and monthly B12 injections are a common treatment. That means the injection is therapeutic, and you should report it with 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular).

You should claim the B12 with J3420 (Injection, vitamin B-12 cyanocobalamin, up to 1,000 mcg). Many patients receive 1,000 mcg per month, and the descriptor indicates you should report one unit for this dose.

Dx tip: The ICD-9 manual specifies that 281.0 is appropriate if the doctor documents Addison's anemia, Biermer's anemia, congenital pernicious anemia or congenital intrinsic factor (Castle-s) deficiency.