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Anemia: ICD-10-CM Guidelines Update Clarification

Anemia: ICD-10-CM Guidelines Update Clarification

Understand the many nuances of this blood disease to code it correctly.

Anemia, according to Mayo Clinic, is a condition in which the body isn’t making enough healthy red blood cells to carry adequate oxygen to the body’s tissues. That’s why common manifestations are feelings of weakness and tiredness. There are many types of anemia and many causes; it can be temporary or long-term, and with different levels of severity.

ICD-10-CM chapter-specific guidelines (Chapter 3: Diseases of Blood/Blood-Forming Organs & Disorders Involving Immune Mechanism) are currently reserved for future guideline expansion. However, you can find anemia coding guidelines in other chapters because of anemia’s overlap with other conditions.

Knowing where to look for these guidelines is key to coding properly.

Anemia Associated With Malignancy

Code sequencing matters when the admission/encounter is for management of anemia associated with malignancy, and the treatment is only for the anemia. According to ICD-10-CM guidelines, the appropriate code for the malignancy is sequenced as the principal (or first-listed) diagnosis, followed by the appropriate code for the anemia.

Example: Mr. Doe is admitted due to anemia secondary to his prostate cancer, for which he is undergoing oral chemotherapy. Patient has PMH of COPD, CKD III, HTN.

Diagnosis coding:

C61        Malignant neoplasm of prostate

D63.0    Anemia in neoplastic disease

I12.9     Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease

N18.9    Chronic kidney disease, unspecified

J44.9     Chronic obstructive pulmonary disease, unspecified

Under D63.0 is an official guideline reference that tells you where to look for the guidelines specific to this code. There is also a Code first alert stating, “Code first neoplasm (C00-D49),” followed by EXCLUDES1 and EXCLUDES2 notes.

Anemia due to Chemotherapy, Immunotherapy, or Radiation Therapy

What if the reason for admission is for management of anemia associated with an adverse effect of chemotherapy or immunotherapy, and the treatment is only for the anemia? In this case, sequence the anemia code first, followed by the codes for the neoplasm and the adverse effect.

Example: Ms. Doe is admitted for anemia due to oral chemotherapy drug for her breast cancer. Patient has PMH of COPD, CKD III, HTN.

Diagnosis coding:

D64.81     Anemia due to antineoplastic chemotherapy

C50.919   Malignant neoplasm of unspecified site of unspecified female breast

T45.1X5-  Adverse effect of antineoplastic and immunosuppressive drugs




Anemia With (due to) (in) Guideline

When a patient has chronic kidney disease (CKD) and anemia, assign the appropriate code from category N18 Chronic kidney disease (CKD) and code D63.1 Anemia in chronic kidney disease.

This is also true with end-stage renal disease (ESRD) and anemia: Assign D63.1 for the erythropoietin resistant anemia. (Do not use D64.9 Anemia, unspecified in this case.) Another example is neoplasm and anemia: Assign D63.0.

This is in line with the American Hospital Association’s Coding Clinic and the ICD-10-CM guidelines, which state, “The word ‘in’ or ‘with’ should be interpreted to mean ‘associated with’ or ‘due to’ when it appears in a code title, the Alphabetic Index (either under a main term or subterm), or an instructional note in the Tabular List.”

The classification presumes a causal relationship between the two conditions, linked by these terms in the Alphabetic Index or Tabular List. Look up Anemia as your main term to locate “with (due to) (in),” wherein you will find the condition listed under “due to (in)(with).” CKD, ESRD, and neoplasm presume a causal relationship with anemia.

Example: Ms. Smith is admitted due to anemia. She has breast cancer, which is being treated with oral chemotherapy. She has PMH of COPD, CKD III, HTN.

Diagnosis coding:

C50.919 Malignant neoplasm of unspecified site of unspecified female breast






Fortify Your Coding

Anemia is very common but may present for any number of reasons. You must know the reason to code this condition correctly and with the utmost specificity. If it is not clear in the documentation, query the provider.

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Angelica Mae Celis-Duran, RN, CPC, BCHH-C, CPMA, has been coding for eight years, working with inpatient, outpatient, and hierarchical condition category coding, as well as Healthcare Quality Patient Assessment Form, home health, and evaluation and management coding. Celis-Duran is a process coach for the home health coding department of Global Healthcare Resource, Philippines. She is a member of the Makati, Philippines, local chapter.

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