Wiki Anemia and Cancer

[aileonard]

If a provider documents Breast Cancer C50.912 and Anemia, what code would you use for the anemia? I have been told to use D63.0 because if the pt has cancer, you would think the anemia is due to cancer even though it does not state that in the note. I thought it had to state anemia due to malignancy in the note to code D63.0.

Can someone please clarify?

Thanks

 

[sls314]

If the provider only says "anemia" without specifically stating the cause, you'd need to use D64.9. Which of course can cause problems with prior authorizations and claims.

This could be a good topic for educating the providers on documentation improvement. They should be as specific as possible - it's not enough to just say that a patient has anemia.

 

[sls314]

If a provider documents Breast Cancer C50.912 and Anemia, what code would you use for the anemia? I have been told to use D63.0 because if the pt has cancer, you would think the anemia is due to cancer even though it does not state that in the note. I thought it had to state anemia due to malignancy in the note to code D63.0.

Can someone please clarify?

Thanks

You are correct. The provider should be documenting that the anemia is caused by the malignancy. It is not an automatic linkage.

In the ICD-10-CM alphabetic index, these are the only terms listed immediately under the main term Anemia using the word "With". This means that the 2 conditions listed below are the only ones for which linkage is assumed. (Note that malignancy is NOT listed there):

Anemia (essential) (general) (hemoglobin deficiency) (infantile) (primary) (profound)D64.9

• with (due to) (in)
  • disorder of
    • anaerobic glycolysisD55.29
    • pentose phosphate pathwayD55.1

This is from the "With" convention of the ICD-10-CM guidelines:

For conditions not specifically linked by these relational terms in the classification or when a guideline requires that a linkage between two conditions be explicitly documented, provider documentation must link the conditions in order to code them as related. The word “with” in the Alphabetic Index is sequenced immediately following the mainterm or subterm, not in alphabetical order.

Note also that the ICD-10-CM guidelines for Chapter 2 Neoplasms state to "use the appropriate code for the anemia," and then gives D63.0 as one example. Remember that there's more than one anemia code that could be used in oncology. You don't know if the neoplasm was caused by chemotherapy (D64.81 or D61.1), the neoplasm (D63.0), or something else entirely if the provider doesn't state that specifically in the documentation.

1) Anemia associated with malignancy

When admission/encounter is for management of an anemia associated with the malignancy, and the treatment is only for anemia, the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis followed by the appropriate code for the anemia (such as code D63.0, Anemia in neoplastic disease).

 

[aileonard]

You are correct. The provider should be documenting that the anemia is caused by the malignancy. It is not an automatic linkage.

In the ICD-10-CM alphabetic index, these are the only terms listed immediately under the main term Anemia using the word "With". This means that the 2 conditions listed below are the only ones for which linkage is assumed. (Note that malignancy is NOT listed there):

Anemia (essential) (general) (hemoglobin deficiency) (infantile) (primary) (profound)D64.9

• with (due to) (in)
  • disorder of
    • anaerobic glycolysisD55.29
    • pentose phosphate pathwayD55.1

This is from the "With" convention of the ICD-10-CM guidelines:

For conditions not specifically linked by these relational terms in the classification or when a guideline requires that a linkage between two conditions be explicitly documented, provider documentation must link the conditions in order to code them as related. The word “with” in the Alphabetic Index is sequenced immediately following the mainterm or subterm, not in alphabetical order.

Note also that the ICD-10-CM guidelines for Chapter 2 Neoplasms state to "use the appropriate code for the anemia," and then gives D63.0 as one example. Remember that there's more than one anemia code that could be used in oncology. You don't know if the neoplasm was caused by chemotherapy (D64.81 or D61.1), the neoplasm (D63.0), or something else entirely if the provider doesn't state that specifically in the documentation.

1) Anemia associated with malignancy

When admission/encounter is for management of an anemia associated with the malignancy, and the treatment is only for anemia, the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis followed by the appropriate code for the anemia (such as code D63.0, Anemia in neoplastic disease).

Thank you so much for the clarification. I thought it needed to be documented as linked to code D63.0.

 

[natashalage]

I have a different opinion about it and I am sorry, I am not an expert and still learning. I looked at Encoder Index and 3M software, both have submenu with Linking words 'in', 'due to', 'with' which tells us to bill D63.0 when pt has Anemia and Cancer even if documentation does not link them together. I would say if MD documents that these 2 conditions are not related then we code a regular Anemia. I am eager to hear other thoughts on this topic. Thank you to all in advance.

 

[sls314]

I have a different opinion about it and I am sorry, I am not an expert and still learning. I looked at Encoder Index and 3M software, both have submenu with Linking words 'in', 'due to', 'with' which tells us to bill D63.0 when pt has Anemia and Cancer even if documentation does not link them together. I would say if MD documents that these 2 conditions are not related then we code a regular Anemia. I am eager to hear other thoughts on this topic. Thank you to all in advance.
View attachment 6786

It's not a matter of opinion. It's a matter of understanding and applying the ICD-10-CM guidelines correctly.

The ICD-10-CM guidelines specifically state that the convention applies to the word "with" in the Alphabetic Index sequenced immediately following the main term or subterm, not in alphabetical order.



The fact that there's a parenthetical (with) following the word "In" in the alphabetic index does not mean that the With convention of the ICD-10-CM guidelines applies.

In the alphabetic index, the convention only applies to the subterm "With" when it immediately follows the main term. Not any other appearance of the word "with" that happens to be in the remaining list.

 

[PennyR]

If the patient has cancer and it is not specified what type of anemia they have, you are to code D63.0
Per the guidelines, "The word "with" or "in" should be interpreted to mean "associated with" or "due to" when it appears in a code title..."
I remember a few years ago having a discussion with our auditors regarding this exact same thing.

Penny Walker, Provider Coding Specialist, CPC, CHONC, CCC