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v1.0.0
ICD-10 Guide
ICD-10 CodesD61.818

D61.818

Billable

Other pancytopenia

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

Code Description

ICD-10 D61.818 is a billable code used to indicate a diagnosis of other pancytopenia.

Key Diagnostic Point:

Pancytopenia is a hematological condition characterized by the simultaneous reduction of red blood cells, white blood cells, and platelets. The code D61.818 specifically refers to cases of pancytopenia that do not fall under the more common categories such as aplastic anemia or hereditary conditions. Aplastic anemia, a significant cause of pancytopenia, results from bone marrow failure, leading to a decrease in hematopoietic stem cells. This can be acquired through various factors including autoimmune diseases, exposure to toxins, or viral infections. Other acquired anemias, such as those resulting from hypersplenism or malignancies, can also lead to pancytopenia. The diagnosis of other pancytopenia requires thorough investigation to identify underlying causes, which may include bone marrow biopsy, blood tests, and imaging studies. Clinicians must differentiate between primary bone marrow disorders and secondary causes to ensure appropriate management. Treatment may involve addressing the underlying cause, transfusions, or immunosuppressive therapy, depending on the etiology.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes requiring thorough documentation
  • Differentiation from other types of anemia and hematological disorders
  • Potential for overlapping symptoms with other conditions
  • Need for comprehensive lab results and imaging studies

Audit Risk Factors

  • Inadequate documentation of underlying causes
  • Failure to specify the type of pancytopenia
  • Misclassification of related hematological disorders
  • Lack of supporting lab results or imaging studies

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 presenting with unexplained anemia, leukopenia, and thrombocytopenia.

Billing Considerations

Ensure all relevant laboratory tests and clinical findings are documented to support the diagnosis.

Oncology

Documentation Requirements

Comprehensive cancer history, treatment regimens, and response to therapy.

Common Clinical Scenarios

Patients with malignancies presenting with cytopenias due to bone marrow infiltration.

Billing Considerations

Document any chemotherapy or radiation therapy that may contribute to bone marrow suppression.

Coding Guidelines

Inclusion Criteria

Use D61.818 When
  • According to ICD
  • CM guidelines, D61
  • 818 should be used when the specific cause of pancytopenia is not classified elsewhere
  • Coders must ensure that the documentation supports the diagnosis and that other specific codes are not applicable

Exclusion Criteria

Do NOT use D61.818 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

85027CPT Code

Complete blood count (CBC) with differential

Clinical Scenario

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

Documentation Requirements

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

Specialty Considerations

Hematologists should ensure that all relevant lab results are included in the patient's record.

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. D61.818 provides a distinct code for cases that do not fit into more defined categories, improving data accuracy and clinical management.

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. D61.818 provides a distinct code for cases that do not fit into more defined categories, improving data accuracy and clinical management.

Reimbursement & Billing Impact

reimbursement.

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 other pancytopenia?

Common causes include autoimmune disorders, hypersplenism, infections, and certain medications that affect bone marrow function.