Febrile neutropenia, also known as neutropenic fever or chemotherapy-induced neutropenia with fever, is a serious medical condition requiring prompt diagnosis and treatment. This page provides information on febrile neutropenia diagnosis, including clinical documentation, medical coding (ICD-10), and management guidelines for healthcare professionals. Learn about the causes, symptoms, and risk factors associated with FN to improve patient care and ensure accurate clinical documentation. This resource supports best practices in healthcare for neutropenic fever and its complications.
Also known as
Agranulocytosis
Severe deficiency of granulocytes (neutrophils, eosinophils, and basophils).
Fever of unknown origin
Fever without an identified cause after appropriate investigation.
Aplastic anemia and other bone marrow failure syndromes
Conditions characterized by insufficient production of blood cells by the bone marrow.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the neutropenia associated with chemotherapy?
Yes
Is there a documented fever?
No
Is there a documented fever?
When to use each related code
| Description |
|---|
| Fever with low neutrophils. |
| Fever during chemotherapy. |
| Low neutrophils without fever. |
Coding severity (e.g., profound, severe, moderate) impacts DRG assignment and reimbursement. CDI review crucial.
Insufficient fever documentation can lead to coding denials. CDI should query for temperature values and timing.
Establishing the causal link between chemotherapy and neutropenia is vital for accurate coding and compliance.
Q: What is the most effective empiric antibiotic treatment for febrile neutropenia in adult oncology patients with high-risk features?
A: For adult oncology patients with high-risk febrile neutropenia (e.g., profound neutropenia expected to last >7 days, presence of hemodynamic instability, or significant comorbidities), current guidelines recommend empiric broad-spectrum antibiotic therapy covering both Gram-positive and Gram-negative bacteria, including Pseudomonas aeruginosa. Common choices include an antipseudomonal beta-lactam (e.g., cefepime, piperacillin-tazobactam, meropenem) combined with an aminoglycoside (e.g., gentamicin, amikacin) or a fluoroquinolone with antipseudomonal activity (e.g., ciprofloxacin, levofloxacin). Vancomycin or other MRSA coverage should be added if there are risk factors such as skin or soft tissue infection, catheter-related infection, or known MRSA colonization. The choice of specific antibiotic regimen should be guided by local resistance patterns and institutional guidelines. Consider implementing a regular review of antibiotic choices based on culture results and clinical response. Explore how antimicrobial stewardship programs can optimize antibiotic use in this patient population.
Q: How do I differentiate between fever due to infection and fever due to the underlying malignancy in a neutropenic patient?
A: Differentiating fever from infection versus underlying malignancy in a neutropenic patient can be challenging. While infection is the most common cause of fever in these patients, malignancy-related fever can also occur. A thorough clinical assessment, including a detailed history, physical exam, and laboratory investigations, is crucial. Look for signs and symptoms suggestive of infection such as localized tenderness, erythema, purulent drainage, or new pulmonary infiltrates. Blood cultures are essential, but negative cultures do not rule out infection. Procalcitonin and C-reactive protein can be helpful adjunctive tests, but their sensitivity and specificity are not absolute. If there is a high clinical suspicion of infection despite negative initial workup, consider further investigations such as imaging studies (e.g., CT scan, ultrasound) or biopsies depending on the clinical context. Learn more about risk stratification tools for febrile neutropenia to aid in clinical decision-making. Consider implementing standardized protocols for evaluating fever in neutropenic patients.
Patient presents with febrile neutropenia, also known as neutropenic fever or chemotherapy-induced neutropenia with fever. The onset of fever, defined as a single oral temperature of 38.3 degrees Celsius or higher, or a temperature of 38.0 degrees Celsius sustained over one hour, is documented. The patient exhibits neutropenia, with an absolute neutrophil count (ANC) less than 500 cells/mm3 or an ANC expected to decline below 500 cells/mm3 within 48 hours. This condition is likely related to the patient's recent chemotherapy regimen (specify regimen and dates). Given the increased risk of infection in patients with febrile neutropenia, a comprehensive evaluation was performed, including a complete blood count with differential, blood cultures, urinalysis, and chest x-ray. The patient's current vital signs are (document specific values). Symptoms accompanying the fever include (document specific symptoms, e.g., chills, fatigue, malaise, hypotension). Based on the clinical presentation and laboratory findings, the diagnosis of febrile neutropenia is established. The patient is being admitted for intravenous broad-spectrum antibiotics (specify antibiotics), supportive care, and close monitoring for signs of infection or sepsis. Neutropenia management, infection prevention, and fever management strategies are being implemented. Prognosis and potential complications, including sepsis and septic shock, have been discussed with the patient. Further diagnostic testing may be indicated depending on the patient's clinical course. ICD-10 code D70.0 and relevant CPT codes for evaluation and management, laboratory tests, and therapeutic procedures will be documented.