Radiology Coding Alert

Question: A patient had a computerized tomography (CT) abdomen/pelvis without contrast. The indication states "vomiting following chemotherapy." What ICD-10 code(s) should I apply?

Ohio Subscriber

Answer: When determining the proper ICD-10 code for an adverse effect, context is absolutely key. Many coders are guilty of improperly coding scenarios where patients experience adverse effects following chemotherapy.

However, in order to code this scenario correctly, you need to have a firm grasp on the known side effects of chemotherapy. Since vomiting and nausea are typical side effects for patients receiving chemotherapy, you will take a different route of coding this situation than if the effects were unintended. Take a look at section I.C.1.9 Adverse effects, poisoning, underdosing and toxic effects in the 2018 ICD-10 guidelines:

"When coding an adverse effect of a drug that has been correctly prescribed and properly administered, assign the appropriate code for the nature of the adverse effect followed by the appropriate code for the adverse effect of the drug (T36-T50). The code for the drug should have a 5th or 6th character '5' (for example T36.0X5-) Examples of the nature of an adverse effect are tachycardia, delirium, gastrointestinal hemorrhaging, vomiting, hypokalemia, hepatitis, renal failure, or respiratory failure."

Based on these guidelines, you should code the vomiting first, followed by the adverse effect of the chemotherapy code. For vomiting, you will apply code R11.10 (Vomiting, unspecified) and for the initial encounter adverse effect of the chemotherapy, you will apply code T45.1X5A (Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter)

In order to find the adverse effect code, you should first open up the Table of Drugs and Chemicals section in ICD-10-CM book. There, you can search under the terms "antineoplastic," "immunosuppressive," or "cancer chemotherapy drug regimen" to find the correct set of codes. You will then select the code listed under "Adverse effect."

Careful: You do not want to use the code listed under "Poisoning, accidental unintentional." Since the physician or nurse practitioner (NP) administered the correct drug and the correct dosage, these effects are a known and expected result of chemotherapy treatment. If, on the other hand, the patient received a much greater dosage than the doctor had prescribed, you could apply code T45.1X1A (Poisoning by antineoplastic and immunosuppressive drugs, accidental (unintentional), initial encounter).