Cracking the Code

Coding Anemia

According to the Mayo Clinic, anemia is defined as “a condition in which the blood doesn’t have enough healthy red blood cells. Anemia results from a lack of red blood cells or dysfunctional red blood cells in the body. This leads to reduced oxygen flow to the body’s organs. Symptoms may include fatigue, skin pallor, shortness of breath, lightheadedness, dizziness, or a fast heartbeat.” When searching for the proper code, start with the main term Anemia in the ICD-10-CM Alphabetic Index. Then look for the sub-term that identifies the type or cause of the anemia. When selecting the code for anemia, review the documentation to see if the provider documented the cause. When the cause is not documented, the code for unspecified anemia (D64.9) is the only option.

It is quite common for cancer patients to develop anemia because of cancer, or because of the cancer treatment (chemotherapy). When the patient develops anemia because of the neoplasm and presents for treatment of the anemia, the code(s) for the malignancy is listed first, followed by the code for the anemia (D63.0). If the anemia is caused by chemotherapy or radiotherapy, the anemia code is reported first, followed by the appropriate codes for the neoplasm and the adverse effect (T45.1X5- or Y84.2).

Q: How would we report the coding when a patient is seen for the management of their anemia due to malignancy?
A: The malignancy is reported first, followed by the code for the anemia. Rationale: ICD-10-CM guideline I.C.2.c.1, when the patient is being seen for management of the anemia associated with malignancy, the code for the malignancy is reported first, followed by the appropriate code for the anemia (for example D63.0 Anemia in neoplastic disease).
Reference: FY 2024 ICD-10-CM Coding Guidelines, AHA Coding Handbook, Mayo Clinic
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