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ICD-10 Guide
ICD-10 CodesD53.1

D53.1

Billable

Other megaloblastic anemias, not elsewhere classified

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 D53.1 is a billable code used to indicate a diagnosis of other megaloblastic anemias, not elsewhere classified.

Key Diagnostic Point:

Megaloblastic anemia is characterized by the presence of large, abnormal red blood cells (megaloblasts) in the bone marrow and peripheral blood. This condition is primarily caused by deficiencies in vitamin B12 or folate, which are essential for DNA synthesis and red blood cell production. Other nutritional factors, such as malabsorption syndromes, certain medications, and chronic diseases, can also contribute to the development of megaloblastic anemia. Patients may present with symptoms such as fatigue, weakness, pallor, and neurological symptoms in cases of vitamin B12 deficiency. Diagnosis typically involves blood tests showing macrocytic anemia, elevated mean corpuscular volume (MCV), and specific vitamin level assessments. Treatment focuses on addressing the underlying cause, which may include vitamin supplementation, dietary modifications, and management of any contributing conditions. It is crucial for healthcare providers to differentiate megaloblastic anemia from other types of anemia, such as iron deficiency anemia, to ensure appropriate treatment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other types of anemia
  • Need for specific laboratory tests to confirm diagnosis
  • Potential overlap with other nutritional deficiencies
  • Variability in clinical presentation

Audit Risk Factors

  • Inadequate documentation of vitamin levels
  • Failure to specify underlying causes
  • Misclassification with other anemia types
  • Lack of follow-up documentation

Specialty Focus

Medical Specialties

Hematology

Documentation Requirements

Detailed lab results, patient history, and treatment plans.

Common Clinical Scenarios

Patients presenting with fatigue and pallor, requiring differential diagnosis of anemia types.

Billing Considerations

Ensure accurate documentation of vitamin levels and any underlying conditions contributing to anemia.

Nutrition

Documentation Requirements

Dietary assessments, nutritional history, and intervention plans.

Common Clinical Scenarios

Patients with malabsorption syndromes or dietary deficiencies leading to megaloblastic anemia.

Billing Considerations

Document dietary intake and any supplementation provided to support coding.

Coding Guidelines

Inclusion Criteria

Use D53.1 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the underlying cause of megaloblastic anemia
  • Include any relevant laboratory findings and clinical assessments

Exclusion Criteria

Do NOT use D53.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

85025CPT Code

Complete blood count (CBC) with automated differential

Clinical Scenario

Used to evaluate anemia and determine the type of anemia present.

Documentation Requirements

Document the reason for the CBC and any relevant clinical findings.

Specialty Considerations

Hematology specialists should ensure comprehensive documentation of findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of megaloblastic anemias, improving the ability to capture the nuances of different types of anemia and their underlying causes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of megaloblastic anemias, improving the ability to capture the nuances of different types of anemia and their underlying causes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of megaloblastic anemias, improving the ability to capture the nuances of different types of anemia and their underlying causes.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the common causes of megaloblastic anemia?

Common causes include vitamin B12 deficiency, folate deficiency, malabsorption syndromes, and certain medications that interfere with vitamin absorption.

How is megaloblastic anemia diagnosed?

Diagnosis is typically made through blood tests showing macrocytic anemia, elevated MCV, and specific assessments of vitamin B12 and folate levels.