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ICD-10 Guide
ICD-10 CodesD61.09

D61.09

Billable

Other constitutional aplastic anemia

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

Code Description

ICD-10 D61.09 is a billable code used to indicate a diagnosis of other constitutional aplastic anemia.

Key Diagnostic Point:

Aplastic anemia is a rare but serious condition characterized by the failure of the bone marrow to produce adequate amounts of blood cells, leading to pancytopenia (a reduction in red blood cells, white blood cells, and platelets). Constitutional aplastic anemia is often hereditary and can be caused by genetic mutations affecting hematopoietic stem cells. Patients may present with symptoms such as fatigue, increased susceptibility to infections, and bleeding tendencies due to low blood cell counts. The condition can be classified into two main categories: acquired and inherited. Acquired aplastic anemia can result from environmental factors, such as exposure to toxins, certain medications, or viral infections. In contrast, constitutional forms are typically linked to genetic syndromes, such as Fanconi anemia or dyskeratosis congenita. Diagnosis is confirmed through blood tests and bone marrow biopsy, which reveals hypocellular marrow. Treatment options may include immunosuppressive therapy, bone marrow transplantation, and supportive care, depending on the severity and underlying cause of the anemia.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation between acquired and constitutional forms of aplastic anemia
  • Need for detailed patient history to identify potential genetic causes
  • Variability in clinical presentation and severity among patients
  • Potential overlap with other hematologic disorders

Audit Risk Factors

  • Insufficient documentation of family history or genetic testing results
  • Failure to specify the type of aplastic anemia
  • Inadequate clinical rationale for treatment choices
  • Lack of follow-up documentation on patient outcomes

Specialty Focus

Medical Specialties

Hematology

Documentation Requirements

Comprehensive patient history, including family history and genetic testing results, along with detailed lab results and treatment plans.

Common Clinical Scenarios

Diagnosis and management of patients with unexplained cytopenias, evaluation of bone marrow biopsy results, and treatment planning for bone marrow transplantation.

Billing Considerations

Hematologists must ensure that all relevant genetic and environmental factors are documented to support the diagnosis of constitutional aplastic anemia.

Genetics

Documentation Requirements

Genetic testing results, family pedigree charts, and detailed clinical evaluations.

Common Clinical Scenarios

Assessment of patients with suspected hereditary blood disorders and counseling families about genetic risks.

Billing Considerations

Geneticists should document the implications of genetic findings on treatment and management of aplastic anemia.

Coding Guidelines

Inclusion Criteria

Use D61.09 When
  • According to ICD
  • 10 coding guidelines, D61
  • 09 should be used when the aplastic anemia is confirmed to be constitutional and not due to external factors
  • Coders must ensure that the documentation supports the diagnosis and that any related conditions are also coded appropriately

Exclusion Criteria

Do NOT use D61.09 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

38220CPT Code

Bone marrow biopsy

Clinical Scenario

Used to confirm the diagnosis of aplastic anemia.

Documentation Requirements

Document indication for the procedure and results of the biopsy.

Specialty Considerations

Hematologists should ensure that the biopsy results are clearly linked to the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of aplastic anemia, including the differentiation between constitutional and acquired forms. This specificity improves data accuracy and enhances the ability to track and manage patient outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of aplastic anemia, including the differentiation between constitutional and acquired forms. This specificity improves data accuracy and enhances the ability to track and manage patient outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of aplastic anemia, including the differentiation between constitutional and acquired forms. This specificity improves data accuracy and enhances the ability to track and manage patient outcomes.

Resources

Clinical References

  • •
    Aplastic Anemia and MDS International Foundation

Coding & Billing References

  • •
    Aplastic Anemia and MDS International Foundation

Frequently Asked Questions

What is the difference between constitutional and acquired aplastic anemia?

Constitutional aplastic anemia is typically hereditary and linked to genetic mutations, while acquired aplastic anemia is often caused by environmental factors, medications, or infections. Accurate coding requires understanding the underlying cause.