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ICD-10 Guide
ICD-10 CodesD61.03

D61.03

Billable

Fanconi anemia

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

Code Description

ICD-10 D61.03 is a billable code used to indicate a diagnosis of fanconi anemia.

Key Diagnostic Point:

Fanconi anemia is a rare genetic disorder characterized by aplastic anemia, which results from the failure of bone marrow to produce sufficient blood cells. This condition is caused by mutations in genes responsible for DNA repair, leading to increased sensitivity to DNA-damaging agents. Patients with Fanconi anemia often present with symptoms of bone marrow failure, including fatigue, pallor, and increased susceptibility to infections due to low white blood cell counts. The disorder can also manifest with physical anomalies, such as short stature, skeletal abnormalities, and skin pigmentation changes. Diagnosis typically involves a combination of clinical evaluation, family history, and specialized tests, including chromosomal breakage studies. Management may include supportive care, blood transfusions, and hematopoietic stem cell transplantation, which is the only curative treatment. Due to the genetic nature of the disorder, genetic counseling is also recommended for affected families. The complexity of coding for Fanconi anemia arises from its association with various hematopoietic disorders and the need for precise documentation of clinical findings and treatment plans.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Genetic testing and documentation requirements
  • Differentiation from other types of aplastic anemia
  • Potential for associated congenital anomalies
  • Need for multidisciplinary management

Audit Risk Factors

  • Inadequate documentation of genetic testing results
  • Failure to document associated congenital anomalies
  • Misclassification of the type of anemia
  • Lack of detailed treatment plans

Specialty Focus

Medical Specialties

Hematology

Documentation Requirements

Comprehensive documentation of blood counts, bone marrow biopsy results, and genetic testing.

Common Clinical Scenarios

Diagnosis and management of patients with unexplained anemia and bone marrow failure.

Billing Considerations

Ensure accurate coding of associated conditions and treatments, including stem cell transplantation.

Genetics

Documentation Requirements

Detailed family history and genetic testing results.

Common Clinical Scenarios

Counseling families with a history of Fanconi anemia and discussing genetic testing options.

Billing Considerations

Document the implications of genetic findings for family members and potential screening.

Coding Guidelines

Inclusion Criteria

Use D61.03 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the diagnosis, associated conditions, and treatments
  • Include details on the genetic basis of the condition and any relevant laboratory findings

Exclusion Criteria

Do NOT use D61.03 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

38220CPT Code

Bone marrow aspiration

Clinical Scenario

Used to evaluate bone marrow function in suspected cases of Fanconi anemia.

Documentation Requirements

Document indications for the procedure and findings.

Specialty Considerations

Hematology specialists should ensure accurate coding based on findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of genetic disorders like Fanconi anemia, improving the accuracy of data collection and reimbursement processes. It emphasizes the need for detailed documentation of genetic testing and associated conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of genetic disorders like Fanconi anemia, improving the accuracy of data collection and reimbursement processes. It emphasizes the need for detailed documentation of genetic testing and associated conditions.

Reimbursement & Billing Impact

reimbursement processes. It emphasizes the need for detailed documentation of genetic testing and associated conditions.

Resources

Clinical References

  • •
    Fanconi Anemia Research Fund

Coding & Billing References

  • •
    Fanconi Anemia Research Fund

Frequently Asked Questions

What is the primary cause of Fanconi anemia?

Fanconi anemia is primarily caused by genetic mutations that affect the body's ability to repair DNA, leading to bone marrow failure and increased cancer risk.