Wiki Post Radiation Syndrome

[suzyrene]

I am looking for some assistance in how to code post radiation syndrome. The Documentation reads

"Patient has history of Other (CA of Larynx) cancer.
Pt had XRT followed by 2 courses of Chemo 3 yrs ago.
Pt now has Laryngeal scarring with difficulty breathing/speaking and swallowing.
CA is resolved.
Pt to undergo Laryngectomy tomorrow

Pt has chronic pain in upper chest secondary to post radiation syndrome.
Patient does not have a pain management plan.
Patient experienced pain Almost constantly over the last 5 days.
Patient reports that over the past 5 days, pain has made it hard to sleep at night.
Patient is limiting their day to day activities because of pain.
Status - controlled.
Continue current treatment"

I am looking at coding the signs and symptoms since there is not a code for the listed post radiation syndrome.

Please provide the rational behind any responses.
Thank you

 

[Tonyj]

I am looking for some assistance in how to code post radiation syndrome. The Documentation reads

"Patient has history of Other (CA of Larynx) cancer.
Pt had XRT followed by 2 courses of Chemo 3 yrs ago.
Pt now has Laryngeal scarring with difficulty breathing/speaking and swallowing.
CA is resolved.
Pt to undergo Laryngectomy tomorrow

Pt has chronic pain in upper chest secondary to post radiation syndrome.
Patient does not have a pain management plan.
Patient experienced pain Almost constantly over the last 5 days.
Patient reports that over the past 5 days, pain has made it hard to sleep at night.
Patient is limiting their day to day activities because of pain.
Status - controlled.
Continue current treatment"

I am looking at coding the signs and symptoms since there is not a code for the listed post radiation syndrome.

Please provide the rational behind any responses.
Thank you

I'd go with; 338.28 Other chronic postoperative pain (inclusive of post procedural) 909.2 Late effect of radiation, E879.2 Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure and V10.21 Personal history of malignant neoplasm of larynx