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v1.0.0
ICD-10 Guide
ICD-10 CodesD56.0

D56.0

Billable

Alpha thalassemia

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

Code Description

ICD-10 D56.0 is a billable code used to indicate a diagnosis of alpha thalassemia.

Key Diagnostic Point:

Alpha thalassemia is a genetic blood disorder characterized by reduced production of alpha globin chains, which are essential components of hemoglobin. This condition arises from mutations in the HBA1 and HBA2 genes located on chromosome 16. The severity of alpha thalassemia varies based on the number of affected genes: individuals with one or two gene deletions may be asymptomatic or exhibit mild anemia, while those with three or four deletions can develop more severe forms, such as hemoglobin H disease or alpha thalassemia major, respectively. Symptoms often include fatigue, pallor, and splenomegaly due to increased hemolysis. Diagnosis typically involves a complete blood count (CBC), hemoglobin electrophoresis, and genetic testing. Management may include regular blood transfusions, iron chelation therapy, and in some cases, hematopoietic stem cell transplantation. Understanding the genetic basis and clinical implications of alpha thalassemia is crucial for effective patient management and counseling.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation based on gene deletions
  • Need for genetic testing to confirm diagnosis
  • Differentiation from other hemolytic anemias
  • Potential for coexisting conditions affecting coding

Audit Risk Factors

  • Inadequate documentation of genetic testing results
  • Failure to specify the type of alpha thalassemia
  • Misclassification with other types of thalassemia
  • Lack of documentation for associated conditions

Specialty Focus

Medical Specialties

Hematology

Documentation Requirements

Detailed lab results, genetic testing reports, and treatment plans.

Common Clinical Scenarios

Management of patients with varying severity of alpha thalassemia, including transfusion protocols.

Billing Considerations

Ensure accurate documentation of hemoglobin levels and any complications arising from the condition.

Genetics

Documentation Requirements

Family history, genetic counseling notes, and results of genetic tests.

Common Clinical Scenarios

Counseling families with a history of thalassemia and discussing reproductive options.

Billing Considerations

Documentation must clearly outline the genetic basis and implications for family members.

Coding Guidelines

Inclusion Criteria

Use D56.0 When
  • According to ICD
  • 10 guidelines, alpha thalassemia is classified under D56
  • Coders must ensure that the diagnosis is supported by clinical documentation, including laboratory results and genetic testing

Exclusion Criteria

Do NOT use D56.0 When
  • Exclusion criteria include other forms of thalassemia and hemolytic anemias that do not involve alpha globin chain deficiencies

Related ICD-10 Codes

Related CPT Codes

85025CPT Code

Complete blood count (CBC) with automated differential

Clinical Scenario

Used to evaluate anemia in patients suspected of having alpha thalassemia.

Documentation Requirements

Ensure CBC results are included in the patient's medical record.

Specialty Considerations

Hematologists may require additional tests based on CBC findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of alpha thalassemia, improving the accuracy of data collection and reimbursement processes. This specificity aids in better understanding the prevalence and management of the condition.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of alpha thalassemia, improving the accuracy of data collection and reimbursement processes. This specificity aids in better understanding the prevalence and management of the condition.

Reimbursement & Billing Impact

reimbursement processes. This specificity aids in better understanding the prevalence and management of the condition.

Resources

Clinical References

  • •
    National Heart, Lung, and Blood Institute - Thalassemia

Coding & Billing References

  • •
    National Heart, Lung, and Blood Institute - Thalassemia

Frequently Asked Questions

What is the difference between alpha and beta thalassemia?

Alpha thalassemia results from mutations affecting alpha globin chain production, while beta thalassemia involves mutations affecting beta globin chains. The clinical manifestations and management strategies differ based on the type and severity of the thalassemia.