Principal diagnosis when patients present with anemia
RHIT, CDIP, CCS, CCS-P
Director of Coding Quality Assurance
AHIMA Approved ICD-10-CM/PCS Trainer
This week our focus is on the sequencing of the principal diagnosis (PDX) when patients present with anemia (Chapter 3 in ICD-10). Anemia is the most common disorder of the blood and it affects about a quarter of the population in the world.
Here are a few examples:
- Patient is admitted with anemia due to chronic kidney disease (CKD) or end stage renal disease (ESRD). CKD/ESRD would be the appropriate PDX selection even when treatment is directed towards the anemia only. Per the instructional notes in ICD-10-CM, code first the underlying cause. The manifestation code would not be appropriate as the PDX.
- Patient is admitted with anemia due to underlying malignancy. The site of the malignancy would be the appropriate PDX selection even when treatment is directed towards the anemia only. Per the instructional notes in ICD-10-CM, code first the neoplasm. When reading the documentation in the record coders should look for documentation to see if this is anemia of the malignancy or if this is due to the treatment of the malignancy (surgical blood loss anemia or drug induced anemia). If not due to the malignancy but due to the treatment of the malignancy then anemia may be appropriate as the PDX.
- Patient is admitted with anemia and malignancy. The physician documents that the anemia is due to the anti-neoplastic drugs that the patient has been taking. In this case, the anemia due to antineoplastic chemotherapy would be sequenced as the PDX and not the malignancy (if the treatment is only directed at the anemia).
- Patient is admitted with anemia due to rheumatoid arthritis and lupus. Treatment is directed at correcting the anemia. The underlying chronic condition of rheumatoid or lupus would be the appropriate PDX selection. Per the instructional notes in ICD-10-CM, code first the underlying chronic condition.
Below are a few definitions of anemia and the types associated with chronic diseases/malignancy. Please keep in mind, this is a very small selection of types of anemia (there are over 400 types but can be divided into three groups…anemia caused by blood loss, anemia caused by decreased or faulty red blood cell production, and anemia caused by destruction of red blood cells).
Anemia—decrease in the amount of RBCs or hemoglobin in the blood
Anemia of Chronic Disease (or of chronic inflammation)—This type of anemia is associated with many underlying chronic disorders including cancer, infections, autoimmune disease, inflammatory diseases or kidney disease being the most common culprits.
Anemia due to Chemotherapy—very common side effect of use of chemotherapy drugs treating malignancy. Chemotherapy reduces the bone marrow’s ability to make red blood cells.
Aplastic Anemia—your marrow stops making new blood cells (red, white, and platelets). The bone marrow stops producing enough new blood cells. The patient is deficient of red blood cells, white blood cells and platelets. Not a single disease but a group of closely related disorders characterized by failure of the bone marrow to produce all three types of blood cells (red, white, and platelets). This is a very rare disorder and only affects about 1,000 people each year in the US.
For additional scenarios and guidance, please see the below references:
ICD-10-CM Official Guidelines for Coding and Reporting FY 2016 (especially pages 26 and 29)
ICD-10-CM and ICD-10-PCS Coding Handbook
The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
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