AHA Coding Clinic® for ICD-9 - 2013 Issue 3; Ask the Editor

Gastrointestinal Bleeding and Blood Loss Anemia due to Colon Malignancy

The patient was admitted to the hospital for workup of generalized weakness, severe hypochromic microcytic anemia, and melena. The provider documented, “Etiology of gastrointestinal bleeding (GI) resulting in anemia is to be established.” The patient underwent diagnostic esophagogastro-duodenoscopy and colonoscopy. The colon biopsy revealed a fungating malignant mass in the colon and right hemicolectomy with side-to-side anastomosis was performed. The provider’s final diagnostic statement listed, “Adenocarcinoma of the transverse colon, acute microcytic hypochromic anemia secondary to blood loss due to GI bleeding.” Since it was determined after study that the GI bleeding (melena) was secondary to the colon malignancy, would the GI bleeding be coded or is it considered a symptom/sign of the colon cancer?  ...

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