Lean How to Use Diagnoses Codes 287.3 and 153.8

287.3 and More Apply to This Case

Question: You are coding for a patient going through ITP, neutropenia, and macrocytic anemia. The physician addressed these in the office visit, including reviewing lab work and medications. Which ICD-9 codes are applicable to these diagnoses?

Answer: Consider the following codes for your case.

ITP: ITP is an abbreviation frequently used for idiopathic thrombocytopenic purpura. You must choose 287.31 (Immune thrombocytopenic purpura) for this diagnosis. The illness includes very low platelet counts. As platelets function to attain clotting, patients may have bruising (ecchymoses) and hemorrhaging. (The ICD-10-CM equivalent is D69.3,Immune thrombocytopenic purpura.)

Neutropenia: In case the only info you have is "neutropenia," report 288.00 (Neutropenia, unspecified). ICD-9-CM includes a lot of other possible codes, however, so check your documentation against the numerous possibilities in the 288.xx (Diseases of white blood cells) and 289.xx (Other diseases of blood and blood-forming organs) ranges. In neutropenia, the patient has a low neutrophil (white blood cell) count in the circulating blood. (ICD-10-CM includes unspecified option D70.9, Neutropenia, unspecified, in addition to six more specific codes in the D70.-, Neutropenia, range.)

Macrocytic anemia: ICD-9-CM includes macrocytic anemia under the unspecified ICD-9 code 281.9 (Unspecified deficiency anemia). The term macrocytic anemia applies to a variety of syndromes involving larger than normal erythrocytes (red blood cells) in the circulating blood. (ICD-10-CM indexes macrocytic anemia to D53.9, Nutritional anemia, unspecified.)

153.8 Applies When Location Is Undetermined

Question: The oncologist's documentation approves the pathologist's diagnosis of primary malignant neoplasm of the colon. The resection specimen involved a portion of the hepatic flexure and transverse colon, however the pathologist reported he couldn't identify the origin of the cancer. What diagnosis code(s) should you use?

Answer: Report ICD-9 code ( source icd 9 http://www.supercoder.com/icd9-codes/ ) 153.8 (Malignant neoplasm of other specified sites of large intestine) for this case. Colon or colorectal cancer can start in the large intestine (colon) or the rectum (end of the colon).

Even though the resection involves specific sites that have their own cancer, 153.1 (Malignant neoplasm of transverse colon) and 153.0 (Malignant neoplasm of hepatic flexure), you must not choose either of those codes.

Here's why: As documentation does not specify the location of the cancer within the specimen, you can't select one of the more specific codes. Instead, you must use ICD9 codes 153.8. An ICD-9-CM text note demonstrates that the code represents "malignant neoplasm of contiguous or overlapping sites of colon whose point of origin cannot be determined."

Infusions: 96360, +96361: Pay Attention to Hydration for Oncology/Hematology Practices

Challenge 3 common areas of confusion.

Questions about accurate hydration coding are by no means rare, whether you're trying to comprehend the basics or need to look into the confusing world of hydration with chemotherapy infusions. Here are the answers to three top hydration medical billing and coding questions .

1. How Does the 31-Minute Rule Apply?

Question: In case we use the initial hydration code for the first half-hour, how do you use the subsequent code? Is it applicable for every half-hour or every hour? What are the existing rules on rounding the time?

Answer: CPT® guidelines instruct you that you must not report 30 minutes or less of hydration distinctly. CPT code 96360 (Intravenous infusion, hydration; initial, 31 minutes to 1 hour) is correct for the initial 31 to 60 minutes of hydration time, as per the definition. Consequently, 96360 will be sufficient for up to 90 minutes of hydration.

Here's why: For CPT code 96360, documentation should indicate more than 30 minutes (that is, 31 minutes or more) of hydration therapy. Likewise, for +96361 (… each additional hour [List separately in addition to code for primary procedure]) documentation should indicate more than 30 minutes of hydration therapy beyond a one-hour increment of the initial service. Thus in case 96360 is the initial service, +96361 is not correct until the patient has had at least 91 minutes of hydration (60 minutes plus 31 minutes).

2. How Do You Code Hydration Following an IV Push?

Question: Staff administered chemotherapy through intravenous (IV) push. Then, staff administered 95 minutes of hydration. How should you report the administration codes for this encounter?

Answer: In case the patient received chemotherapy via IV push and subsequently received 95 minutes of hydration, you would use CPT code 96409 (Chemotherapy administration; intravenous, push technique, single or initial substance/drug) for the IV push of chemotherapy and +96361 x 2 for the hydration, as supported by the documentation.

Notice that the accurate hydration coding involves +96361 (each additional hour) and not 96360 (initial).

Here's why: You must report CPT codes 96360 only when the hydration is the "initial" service. (Remember this CPT® guideline: "When administering multiple infusions, injections or combinations, only one ‘initial' service code should be reported for a given date, unless protocol requires that two separate IV sites must be used.") Physician coders must select the initial code based on the primary reason for the patient visit (such as chemotherapy). Facility coders, on the other hand, follow a hierarchy outlined in CPT® guidelines.