therapy induced syndrome without cancer

kemptar

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How would you code a patient that has chemotherapy induced myelodysplastic syndrome? This patient is currently cancer free and is no longer receiving treatment for the cancer but they are still coming in for their darpo shot for the syndrome.
For this you are directed to 289.83 but you are to code the underlying condition first (174.0-174.9). Should I use the "history of" code first as the are no longer receiving treatment for the cancer? Or should I use the cancer code first even if they are no longer receiving treatment for the cancer specifically?A
Advice is appreciated!
 

mjb5019

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query

I don't code oncology, but I am curious as to why it isn't coded 238.75 with an e code for the chemo in therapeutic use?
 

lpetrova

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Since I did not feel comfortable with using the dx of myelofibrosis, I asked this question one of our oncologists. This is her response:

"I would not use myelofibrosis code unless he had it. I would use MDS code 238.75 whether it was de novo MDS (not induced by chemo or radiation) or secondary MDS (that is MDS that was induced by some type of chemo or radiation that the patient received for some other malignancy and the prognosis is worse than de novo MDS and has less of a chance of response). I still do not know what this darpo shot is. Do they mean darbepoietin which is aranesp which could be used for MDS? I suppose they do not mean dacogen."

I would not use "history of" to code the injection. I would use "history of" (as I am certain it would be not only in the Impressions but also all over the pt's chart) in conjunction with an E/M (as a secondary; the primary being MDS for which the pt is undergoing tx).

Sincerely,
 
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