ICD 10 Codes For Anemia

Last modified: Oct 27, 2015.

Coding for anemia in ICD-10 allows the savvy coder to capture a lot of detail, with several significant opportunities for greater reimbursement that we will cover below. First, though, let me briefly go over some key concepts on anemia coding.

Key Concepts In ICD-10-CM Coding For Anemia

First of all, I trust that you don't need a reminder of what anemia is, but if you do, it is basically a condition caused by a deficiency of red blood cells or of hemoglobin in the blood, which in turn causes the patient to feel tired, have pale skin, and so on.

In ICD-10, there are three major types of anemia:

Each of these major types of anemia has a number of more or less well known subtypes:

All you have to do is figure out what type of anemia the chart describes, select the appropriate ICD-0-CM code, and you are good to go.

So far things are pretty self-explanatory, so I'm not going to comment much more on types and subtypes of anemia. The next section, however, is not so obvious, and it is important to understand it, as it can often lead to a mismatch between documentation and reimbursement.

Anemia As A Consequence Of / Due To

Certain types of anemia can often be a consequence of another medical condition or procedure, and when coding such clinical scenarios, it is important to capture the relationship. Let me present a clinical scenarios to illustrate this point:

An elderly female undergoes a total knee replacement surgery. Before the procedure, she had a Hemoglobin of 11.8. After surgery, her Hemoglobin dropped to 7.5gm/dL. What is the best way to code for her anemia?

  1. You could code the two issues separately:
    • M16.0 - ICD-10-CM code for osteoarthritis of the hip -
    • D50.9 - ICD-10-CM code for iron deficiency anemia
    • 0SR90JZ - the ICD-10-PCS code for Replacement of Right Hip Joint with Synthetic Substitute, Open Approach
  2. You can link the two issues:
    • M16.0 - ICD-10-CM code for osteoarthritis of the hip -
    • D62 - ICD-10-CM code for - Acute posthemorrhagic anemia due to hip replacement surgery
    • 0SR90JZ - the ICD-10-PCS code for Replacement of Right Hip Joint with Synthetic Substitute, Open Approach

The second option will bring a better reimbursement, as the anemia is, in this case, a major complication/comorbidity (MCC), thereby increasing the medical severity level of the encounter. You just have to make sure the provider used in the chart language that clearly indicates the anemia was caused by bleeding during the procedure. Proper ways to do that are "due to" or "caused by" or "as a consequence of". Without such language, the coder does not have the authority to link these diagnoses.

There are several types of secondary anemia that would qualify for a higher level of reimbursement through the use of this MCC qualifier, and are very common in daily practice:

  • D63.1 - Anemia in chronic kidney disease
  • D64.81 - Anemia due to antineoplastic chemotherapy
  • D64.2 - Secondary sideroblastic anemia due to drugs and toxins
  • D64.1 - Secondary sideroblastic anemia due to chronic disease