ICD-9-CM Official Guidelines for Coding and Reporting

Please refer to the companion Evolve website for the most current guidelines.

Coding Clinic (2009:4Q:p80-82)¹ states that it is not necessary to assign an E code to identify the adverse effect because that information is included in the code title 285.3, Antineoplastic chemotherapy-induced anemia.

Apply the General Coding Guidelines as found in Chapter 5 and the Procedural Guidelines as found in Chapter 6.

ICD-10-CM Official Guidelines for Coding and Reporting

Please refer to the companion Evolve website for the most current guidelines.

Apply the General Coding Guidelines as found in Chapter 5 and the Procedural Guidelines as found in Chapter 7.

Guideline Differences between ICD-9-CM and ICD-10-CM

There are no official guidelines in ICD-10-CM at this time regarding diseases of the blood and blood-forming organs. However, there is a change in how anemia due to a neoplastic disease is sequenced if the patient is being treated primarily for anemia. There is an ICD-9-CM guideline concerning this in the neoplasm chapter. However, in the ICD-10-CM Tabular, there is an instructional notation under code D63.0, Anemia in neoplastic disease, to first code the neoplasm (C00 to D49). This could make a difference in the assignment of a principal diagnosis when a patient is being treated only for anemia.

In ICD-10-CM, there are also instructions in the Tabular to “code first the underlying disease” when the anemia is due to chronic kidney disease (CKD) or some other specified chronic disease.

Major Differences between ICD-9-CM and ICD-10-CM

Most of the codes from ICD-9-CM Chapter 4 are included in ICD-10-CM Chapter 3. In ICD-10-CM, there are some codes from ICD-9-CM, Chapter 1, Infectious and Parasitic Diseases (e.g., D86 sarcoidosis), and Chapter 3, Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders.

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, number, 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 include 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:

See Table 11-1 for normal values.

Disease Conditions

Chapter 4 in the ICD-9-CM code book focuses on Diseases of the Blood and Blood-Forming Organs (280-289). This relatively small chapter is the only chapter that is not divided into sections. Of interest is an Excludes note that appears at the very beginning of the chapter. This signifies that the instructions given in the note pertain to the entire chapter. The Excludes note shown in Figure 11-1 instructs the coder to refer to code 648.2 for anemia complicating pregnancy or the puerperium. Because anemia is a condition that is commonly associated with pregnancy and the puerperium, this topic will be covered in Chapter 16, Complications of Pregnancy, Childbirth, and the Puerperium.

Neoplastic diseases of the blood, such as leukemia, are discussed in Chapter 15, Neoplasms; hematologic disorders involving newborns are addressed in Chapter 17, Congenital Anomalies and Perinatal Conditions. The Excludes note under code 282.0, hereditary spherocytosis, excludes hemolytic anemia of the newborn (773.0-773.5), as is illustrated in Figure 11-2.

Although ICD-9-CM is not divided into sections, ICD-10-CM is divided into the following categories:

Deficiency Anemias

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 for ICD-9-CM. Some of the reasons for iron deficiency include the following:

 Inadequate intake of iron in the diet

 Chronic blood loss

 Impaired absorption during digestion

 Liver disease

 Infection

 Cancers (neoplasms)

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 chronic illness, anemia in end-stage renal disease/chronic kidney disease, and anemia in neoplastic disease. The term chronic anemia is not equated to “chronic simple anemia” or “anemia in chronic disease” (Figure 11-4). Chronic anemia is coded to 285.9 (D64.9) because no specific subterm is available for chronic, so the default code for anemia (285.9) code is assigned.

Example

Patient is being treated as an outpatient for anemia due to inadequate dietary iron intake, 280.1 (D50.8).

Example

Patient is being treated for folate deficiency anemia, 281.2 (D52.9).

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