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Question: We had a patient come in suffering from nausea and vomiting; they have cervical cancer and are awaiting chemotherapy. They were given treatment for nausea, and our provider listed their final diagnoses for the encounter as nausea, vomiting, and cervical cancer. In this situation, should nausea and vomiting be coded as primary? Or, because nausea and vomiting are signs and symptoms related to the neoplasm, should the neoplasm be first-listed and the symptoms be listed at all?

Massachusetts Subscriber

Answer: In situations like this, where treatment is directed to complications related to the neoplasm and not to the neoplasm itself, you should follow the instructions contained in ICD-10-CM guideline I.C.2.l.4. This tells you that if the complication (other than anemia) is 鈥渁ssociated with a neoplasm 鈥� and the treatment is only for the complication,鈥� then you should code the complication first 鈥渇ollowed by the appropriate code for the neoplasm.鈥�

So, you will code the nausea and vomiting first using R11.2 (Nausea with vomiting, unspecified), then the code for the associated neoplasm: in this case, C53.9 (Malignant neoplasm of cervix uteri, unspecified).

Remember: If your provider determines the cause of the patient鈥檚 nausea and vomiting is the result of the patient鈥檚 reaction to chemotherapy, and not a result of the cancer, then your coding for the scenario will change. In this case, you would code the nature of the adverse effect, R11.2, followed by the code for the adverse effect of the drug 鈥� T45.1X5- (Adverse effect antineoplastic drugs) and C53.9 if the underlying neoplasm was also addressed as part of the visit assessment and plan.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC