Q&A: Choosing a principal diagnosis between anemia and malignancy

Q: If a patient is admitted for anemia related to a malignancy and is treated only for anemia, the principal diagnosis goes to the malignancy. I understand that the malignancy was the root cause of the condition making it the principal diagnosis, but what if the patient was treated for other conditions besides anemia at the same time? Could you still code for the malignancy as the principal diagnosis?

A: Code assignment for neoplasms is often confusing. The ICD-10-CM Official Guidelines for Coding and Reporting tell us that if the reason for admission is directed towards the neoplasm, whether primary or secondary site, then the neoplasm would be the principle diagnosis. When an encounter is for management of a complication associated with a neoplasm, however, such as dehydration, and the treatment is only for the complication, the complication is coded first, followed by the appropriate code(s) for the neoplasm.

You are correct that the exception to this guideline is anemia. As stated, when the 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 code D63.0, Anemia in neoplastic disease. So as CDI specialists, we need to review the medical record to see exactly what treatment the patient received, and why, to determine what the principle diagnosis will be. Remember that, although more than one condition may be treated during an encounter, only one principle diagnosis is allowed. Therefore, we need to determine what the majority of care was directed towards to determine the principle diagnosis.

Editor’s Note: Sharme Brodie RN, CCDS, CDI education specialist and CDI Boot Camp instructor for HCPro in Middleton, Massachusetts, answered this question. For information, contact her at sbrodie@hcpro.com. For information regarding CDI Boot Camps offered by HCPro, visit www.hcprobootcamps.com/courses/10040/overview.