285.3 vs. 284.89: Documentation of 'Aplastic' Can Lead to Accurate Coding

Know which condition is more probable to be caused by chemotherapy.

Patients with cancer might develop anemia from numerous cases. Here are some clues to help you identify the source and keep your medical coding compliant.

This article digs into proper anemia medical coding, looking at ICD-9 codes for anemia caused by treatment and at how guidelines are expected to change when ICD-10 use becomes mandatory in 2013.

Reassess Documentation Before You Assign 284.89

When documentation shows that antineoplastic chemotherapy caused a patient's anemia, you need to consider two ICD-9 codes:
285.3 (Antineoplastic chemotherapy induced anemia)
284.89 (Other specified aplastic anemias, due to drugs)

The main dissimilarity between the two is that 284.89 mentions "aplastic" anemia. Aplasia implies that the bone marrow is wiped,as per Coding Clinic for ICD-9-CM (2009, vol. 26, no. 4).

Antineoplastic chemotherapy induced anemia is not generally an aplastic process. The anemia is likely to be short term, however it might range from mild to severe. Thus 285.3 may be applicable to your patient's claims more often than 284.89, however you must let documentation direct your choice. Before you assign 284.89, ensure that the documentation shows the anemia is aplastic and due to drugs.

Expect a Shake-Up When ICD-10 Begins

Paying close attention to diagnosis coding guidelines will become even more vital as you get ready to use ICD-10 in place of ICD-9. To be specific, the ICD-10 2011 guidelines for anemia coding are different from those you know for ICD-9.

Example 1: A patient comes for treatment of just anemia. The physician documents that the patient's neoplasm caused the anemia to develop.

In ICD-9 2012 guidelines, your first-listed code must report the anemia (285.22). The correct malignancy code(s) must follow (ICD-9, Section I.C.2.c.1).

In case you were instead applying ICD-10 2011 guidelines, you would report the malignancy code first and then the anemia code, D63.0 (Anemia in neoplastic disease) (ICD-10, Section I.C.2.c.1).

Example 2: Another patient comes for treatment of just anemia. For this patient, the physician documents that the anemia is because of chemotherapy or immunotherapy.

Using ICD-9 guidelines, your first-listed code must denote anemia (such as 285.3). You smust report the neoplasm as an added code (ICD-9, Section I.C.2.c.2).

On the other hand, the 2011 ICD-10 guidelines ask you to use an adverse effect code as your first-listed code. Your anemia and neoplasm codes must follow that (ICD-10, Section I.C.2.c.2).

Remember: The guidelines given above reflect ICD-10 2011 guidelines. When ICD-10 goes into effect on Oct. 1, 2013, you will apply the official ICD-10 coding guidelines in effect for the pertinent date of service.

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