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v1.0.0
ICD-10 Guide
ICD-10 CodesD61.81

D61.81

Billable

Pancytopenia

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

Code Description

ICD-10 D61.81 is a billable code used to indicate a diagnosis of pancytopenia.

Key Diagnostic Point:

Pancytopenia is a hematological condition characterized by the simultaneous reduction of red blood cells, white blood cells, and platelets in the blood. This condition can arise from various underlying causes, including aplastic anemia, bone marrow failure, and other acquired anemias. Aplastic anemia, a primary cause of pancytopenia, is a disorder where the bone marrow fails to produce adequate blood cells due to damage from autoimmune diseases, toxins, or infections. Bone marrow failure syndromes can also lead to decreased hematopoiesis, resulting in similar cytopenias. Acquired anemias, such as those resulting from nutritional deficiencies or chronic diseases, can contribute to the development of pancytopenia. The clinical presentation may include symptoms of anemia (fatigue, pallor), increased susceptibility to infections (due to leukopenia), and bleeding tendencies (due to thrombocytopenia). Diagnosis typically involves a complete blood count (CBC), bone marrow biopsy, and additional tests to identify the underlying cause. Management strategies depend on the etiology and may include transfusions, immunosuppressive therapy, or hematopoietic stem cell transplantation.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variety of underlying causes requiring differential diagnosis
  • Need for precise documentation of laboratory findings
  • Potential for overlapping symptoms with other hematological disorders
  • Variability in treatment approaches based on etiology

Audit Risk Factors

  • Inadequate documentation of laboratory results
  • Failure to specify the underlying cause of pancytopenia
  • Misclassification of the type of anemia
  • Inconsistent coding of associated conditions

Specialty Focus

Medical Specialties

Hematology

Documentation Requirements

Detailed lab results, bone marrow biopsy reports, and treatment plans.

Common Clinical Scenarios

Diagnosis and management of patients with unexplained cytopenias, evaluation of bone marrow function.

Billing Considerations

Ensure comprehensive documentation of all hematological parameters and any relevant comorbidities.

Oncology

Documentation Requirements

Oncological history, treatment regimens, and response to therapy.

Common Clinical Scenarios

Management of pancytopenia in patients undergoing chemotherapy or radiation therapy.

Billing Considerations

Document the relationship between cancer treatment and hematological status.

Coding Guidelines

Inclusion Criteria

Use D61.81 When
  • Follow official ICD
  • CM coding guidelines, ensuring accurate documentation of the underlying cause of pancytopenia
  • Include relevant lab results and clinical findings to support the diagnosis

Exclusion Criteria

Do NOT use D61.81 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

85025CPT Code

Complete blood count (CBC) with differential

Clinical Scenario

Used to evaluate patients presenting with symptoms of anemia or bleeding.

Documentation Requirements

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

Specialty Considerations

Hematologists should ensure that all relevant parameters are included in the CBC.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of pancytopenia, enabling better tracking of underlying causes and treatment outcomes. This specificity aids in research and improves patient care.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pancytopenia, enabling better tracking of underlying causes and treatment outcomes. This specificity aids in research and improves patient care.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of pancytopenia, enabling better tracking of underlying causes and treatment outcomes. This specificity aids in research and improves patient care.

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 is the primary cause of pancytopenia?

The primary cause of pancytopenia can vary, but aplastic anemia is one of the most common causes, where the bone marrow fails to produce sufficient blood cells.