ICD-9 2012 Choices for Thalassemia Coding

The ICD-9 2012 codes went into effect on October 1 this year; here are some ICD-9 tips to ramp up your oncology coding.

This time ICD-9 2012 has added six new codes for thalassemia: 282.40, 282.43, 282.44, 282.45, 282.46, and 282.47.

ICD-9-CM codes: Under the previous ICD-9, there was a one ICD-9-CM code to capture all non-sickle cell related thalassemias. This one ICD-9 code covers the entire range from asymptomatic patients (silent carrier or thalassemia trait) to patients with severe disease (thalassemia major)

A big portion of thalassemia patients are asymptomatic. Those who suffer from the most severe forms need life-long monthly blood transfusions, iron overload monitoring, chelation therapy and they're candidates for hematopoietic stem cell transplant.

Important: You should review the inclusion list for all of the 282.4x codes. For instance, the list with 282.46 clarifies the code is proper if documentation points to 'silent carrier' or thalassemia trait."

In addition, changes to the inclusion notes for 282.49 show a change for how you code microdrepanocytosis. In place of coding the condition to 282.49 (as you did in the previous one), the recent inclusion note revisions guide you to code the condition to 282.41.

For Pancytopenia, you should mark 284.1 as Invalid. Yet another important change is that now 284.1 is no longer a valid code.

Now you'll need to add a fifth digit: 284.11, 284.12, and 284.19.

Under 2011 ICD-9, coders were confused about how to report drug-induced pancytopenia. The Diagnosis Agenda points to 284.89 as the 2011 code. However since pancytopenia related to drugs wouldn't necessarily be related to aplastic anemia, ICD-9 added the more specific 284.1x codes.

You should split 793.1 to get new SPN code

Make it a point to highlight this change in your coding references, too. Under ICD-9 2012 , 793.1 is no longer a valid code. This time it adds required fifth digit choices for 793.1x.

The changes allow for more specific reporting of a solitary pulmonary nodule (SPN). A patient may have more than one SPN present and each may be in a distinct anatomic area. Doctors may find out SPNs using X-ray, CT, or PET, and biopsy can later recognize the nature of the disease or condition the SPN is related to.