Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism
(ICD-10-CM Chapter 3, Codes D50-D89)
Learning Objectives
2. Identify pertinent anatomy and physiology of the blood and blood-forming organs and immune mechanism
3. Identify diseases of the blood and blood-forming organs and immune mechanism
5. Identify laboratory values and diagnostic tests
6. Explain the importance of documentation in relation to MS-DRGs for reimbursement
Abbreviations/Acronyms
ASA aspirin
DIC disseminated intravascular coagulation
GVHD graft-versus-host disease
Hct hematocrit
Hgb hemoglobin
HIV human immunodeficiency virus
ICD-9-CM International Classification of Diseases, 9th Revision, Clinical Modification
ICD-10-CM International Classification of Diseases, 10th Revision, Clinical Modification
ICD-10-PCS International Classification of Diseases, 10th Revision, Procedure Classification System
ITP idiopathic thrombocytopenic purpura
MS-DRG Medicare Severity diagnosis-related group
PTT partial thromboplastin time
SCID severe combined immunodeficiency
WBC white blood cell
ICD-10-CM Official Guidelines for Coding and Reporting
Please refer to the companion Evolve website for the most current guidelines.
3. Chapter 3: Disease of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)
Reserved for future guideline expansion.
Although there are no ICD-10-CM guidelines specifically for Chapter 3, there are a couple of guidelines that affect the coding and sequencing of anemia when it is associated with a malignancy or the treatment of a malignancy.
2. Chapter 2: Neoplasms (C00-D49)
c. Coding and sequencing of complications
Coding and sequencing of complications associated with the malignancies or with the therapy thereof are subject to the following guidelines:
1) Anemia associated with malignancy
When admission/encounter is for management of an anemia associated with the malignancy, and the treatment is only for anemia, the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis followed by the appropriate code for the anemia (such as code D63.0, Anemia in neoplastic disease).
2) Anemia associated with chemotherapy, immunotherapy and radiation therapy
When the admission/encounter is for management of an anemia associated with an adverse effect of the administration of chemotherapy or immunotherapy and the only treatment is for the anemia, the anemia code is sequenced first followed by the appropriate codes for the neoplasm and the adverse effect (T45.1X5, Adverse effect of antineoplastic and immunosuppressive drugs).
When the admission/encounter is for management of an anemia associated with an adverse effect of radiotherapy, the anemia code should be sequenced first, followed by the appropriate neoplasm code and code Y84.2, Radiological procedure and radiotherapy as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure.
Apply the General Coding Guidelines as found in Chapter 5 and the Procedural Coding Guidelines as found in Chapters 6 and 7.
Anatomy and Physiology
Blood is a viscous fluid that circulates through the vessels of the circulatory system as a result of the pumping action of the heart. Blood has three major functions. First, it transports oxygen, nutrients, hormones, enzymes, waste products, and carbon dioxide to and from cells. Second, blood promotes homeostasis and regulates body temperature. Homeostasis means balance or equilibrium. It is the ability of an organism or cell to maintain internal equilibrium by adjusting its physiologic processes. Third, blood provides a protective mechanism that combats foreign materials and assists in the body’s defense against disease. Blood loss is prevented by clotting mechanisms within the body.
Blood is composed of plasma and formed elements or corpuscles. Corpuscles include erythrocytes (red blood cells), leukocytes (white blood cells), and platelets or thrombocytes. All of these components differ in terms of appearance, structure and type, function, life span, numbers, and means of production. Erythrocytes, or red blood cells, are made within the marrow of the bones; their main responsibility is to carry oxygen throughout the body and remove carbon dioxide. These are the cells that give blood its red color. Leukocytes, or white blood cells, increase in number to battle infection, inflammation, and other diseases. Five different types of white blood cells have been identified, and each has a role in fighting infection. White cells are comprised of neutrophils, monocytes, lymphocytes, eosinophils, and basophils. Platelets or thrombocytes circulate in the blood and assist in the clotting process.
Complete blood count (CBC) is a blood test that is commonly used to evaluate a patient’s overall health; it detects a variety of disorders such as anemia, infection, and leukemia. This test measures the following:
Hemoglobin (Hgb), a protein in red blood cells that carries oxygen to body tissues
Hematocrit (Hct), the percentage of blood volume made up of red blood cells
White blood cells (WBCs), which fight infection
See Table 11-1 for normal values.
TABLE 11-1
| WBC 5000-10,000 mm3 or µL | |
| Differential: | |
| Segs (polyps) | 54%-62% |
| Lymphs | 20%-40% |
| Eos | 1%-3% |
| Baso | 0%-1% |
| Mono | 3%-7% |
| RBC | (M) 4.5-6.0 million per mm3 or µL (F) 4.0-5.5 million per mm3 or µL |
| Hct | (M) 40%-50% (F) 37%-47% |
| HGB | (M) 14-16 g/dL (F) 12-14 g/dL |
| Platelets | 150,000-350,000/mm3 or µL |
The immune system, the body’s major defense mechanism, responds to invasion of the body by foreign substances. The immune system consists of lymphoid tissues such as thymus, bone marrow, tonsils, adenoids, spleen, and appendix. When the immune system malfunctions and homeostasis is interrupted, the response may be classified as one of the following:
Disease Conditions
Chapter 3 in ICD-10-CM focuses on Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism (D50-D89). Of interest is an Excludes2 note that appears at the beginning of the chapter (Figure 11-1). This note applies to the entire chapter. An Excludes2 note means that these conditions are not coded within this chapter, but it is possible for a patient to have one of these conditions with a condition from this chapter. The Excludes1 note under category D58 is a pure Excludes note. This means codes from category P55.- cannot be assigned with any codes from category D58.- (Figure 11-2). This chapter also includes conditions involving the immune mechanism.
Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism (D50-D89), Chapter 3 in the ICD-10-CM code book, is divided into the following categories:
| CATEGORY | SECTION titles |
| D50-D53 | Nutritional anemias |
| D55-D59 | Hemolytic anemias |
| D60-D64 | Aplastic and other anemias and other bone marrow failure syndromes |
| D65-D69 | Coagulation defects, purpura, and other hemorrhagic conditions |
| D70-D77 | Other disorders of blood and blood-forming organs |
| D78 | Intraoperative and postprocedural complications of the spleen |
| D80-D89 | Certain disorders involving the immune mechanism |
Nutritional Anemias (D50-D53)
Anemia occurs when hemoglobin drops, which interrupts the transport of oxygen throughout the body. The most common type of anemia is iron deficiency anemia. In women, this condition is often due to heavy blood loss during menstrual periods. In older men and women, it may be an indication of gastrointestinal blood loss. Pregnant women and children need more iron, so a deficiency is likely due to insufficient iron in the diet. Testing may be necessary to determine a cause.
If a particular cause were determined, it would be appropriate to code the underlying condition. The sequencing of diagnoses would be determined by the coding guidelines and instructional notations in the tabular. Some of the reasons for iron deficiency include the following:
Numerous symptoms can indicate anemia; these include pallor, fatigue, lethargy, cold intolerance, irritability, stomatitis, headache, loss of appetite, numbness and tingling sensations, brittle hair, spoon-shaped and brittle nails, and edema, especially of the ankles. Severe anemia can result in tachycardia, palpitations, dyspnea (difficulty breathing), and syncope (fainting). Treatment depends on the cause, but the approach may be as simple as eating iron-rich foods or taking an iron supplement such as ferrous sulfate or ferrous gluconate. Blood transfusions may be necessary.
Look up the main term “Anemia” in the Index, and see the many subterms for the various types of anemia. “Deficiency” is also a subterm with many subterms, as is shown in Figure 11-3. At the subterm “in,” entries are found for anemia in end-stage renal disease/chronic kidney disease and anemia in neoplastic disease (Figure 11-4). The term chronic anemia is not equated to “chronic simple anemia” or “anemia in chronic disease.” Chronic anemia is coded to D64.9 because no specific subterm is available for chronic, so the default code for anemia code is assigned.
Exercise 11-1
Assign codes to the following conditions.
| 1. Iron deficiency anemia due to chronic blood loss | _______________ |
| 2. Vitamin B12 deficiency anemia | _______________ |
| 3. Megaloblastic anemia | _______________ |
Hemolytic Anemias (D55-D59)
The hemolytic anemias are assigned to hereditary and acquired code categories (Figure 11-5). Hemolytic anemia results from abnormal or excessive destruction of red blood cells. Sickle cell anemia is one of the more common types of hereditary hemolytic anemia; it is found often in the African American population and among people living in Africa, the Mediterranean, Arabia, and South Asia. Red blood cells change from a disc shape to a crescent or “sickle” shape. This causes obstruction of the small blood vessels and eventual damage from thrombus formation, repeated organ infarctions, and tissue necrosis throughout the body. Varying degrees of disease severity and symptoms have been reported. Symptoms include severe anemia, hyperbilirubinemia or jaundice, splenomegaly, delayed and impaired growth and development, vascular occlusion, and infarctions, which can result in permanent damage, pain, frequent infection, and congestive heart failure. ICD-10-CM uses combination code(s) that identifies the sickle cell crisis along with a manifestation such as acute chest syndrome or splenic sequestration. Most treatment is supportive in nature. A drug called Hydrea (hydroxyurea) has reduced the number of crises.
Code D57.3 for sickle cell trait is assigned when a patient is a carrier and the disease has remained asymptomatic. When both sickle cell trait and sickle cell anemia are present, only sickle cell anemia is coded.
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