If anemia is caused by chemotherapy, which code should be reported first?

In cases where anemia is a direct consequence of chemotherapy, the appropriate coding strategy is to report the condition that is primarily responsible for the patient's symptoms and complications. Here, anemia is classified as a result of the treatment for the underlying condition—typically a neoplasm. However, the coding guidelines suggest that when identifying the principal diagnosis, the specific condition causing the significant complication or symptom should be prioritized.

In this scenario, since the anemia is a consequence of chemotherapy, it is most relevant to report the anemia itself first to acknowledge the patient's current state and the reason for medical management. It reflects the urgency and prevalence of the anemia over the underlying neoplasm in clinical assessments and records.

The other conditions such as neoplasm or adverse effects may also be relevant in the overall context, but they do not take precedence over the direct complications being treated. By coding the anemia first, it emphasizes the patient's pressing medical need rather than just the underlying cause of that need.