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ICD-10 Guide
ICD-10 CodesD64.81

D64.81

Billable

Anemia due to antineoplastic chemotherapy

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

Code Description

ICD-10 D64.81 is a billable code used to indicate a diagnosis of anemia due to antineoplastic chemotherapy.

Key Diagnostic Point:

Anemia due to antineoplastic chemotherapy is a condition characterized by a reduction in red blood cell count, hemoglobin concentration, or hematocrit levels resulting from the cytotoxic effects of chemotherapy agents used in cancer treatment. This type of anemia is often classified as an acquired anemia, specifically linked to the suppression of bone marrow function, which is a common side effect of many chemotherapeutic agents. Patients undergoing chemotherapy may experience aplastic anemia, where the bone marrow fails to produce sufficient blood cells, leading to a significant decrease in red blood cells, white blood cells, and platelets. The pathophysiology involves the direct toxicity of chemotherapy drugs on hematopoietic stem cells, resulting in impaired erythropoiesis. Clinically, patients may present with symptoms such as fatigue, pallor, shortness of breath, and increased susceptibility to infections. Monitoring hemoglobin levels and complete blood counts is essential in managing these patients, and supportive care, including blood transfusions or erythropoiesis-stimulating agents, may be necessary to alleviate symptoms and improve quality of life.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of chemotherapy regimens and their side effects.
  • Differentiation from other types of anemia, such as iron deficiency anemia.
  • Need for accurate documentation of chemotherapy history.
  • Potential overlap with other hematologic disorders.

Audit Risk Factors

  • Inadequate documentation of chemotherapy treatment.
  • Failure to document lab results supporting anemia diagnosis.
  • Misclassification of anemia type.
  • Lack of follow-up documentation on patient response to treatment.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed records of chemotherapy regimens, patient responses, and lab results.

Common Clinical Scenarios

Patients receiving chemotherapy for various cancers presenting with fatigue and pallor.

Billing Considerations

Close monitoring of blood counts and timely documentation of any transfusions or supportive care provided.

Hematology

Documentation Requirements

Comprehensive evaluation of blood counts, bone marrow biopsy results, and treatment plans.

Common Clinical Scenarios

Patients with persistent anemia post-chemotherapy requiring further evaluation.

Billing Considerations

Differentiating between chemotherapy-induced anemia and other hematologic disorders.

Coding Guidelines

Inclusion Criteria

Use D64.81 When
  • According to ICD
  • 10 guidelines, D64
  • 81 should be used when the anemia is directly attributable to antineoplastic chemotherapy
  • Coders must ensure that the chemotherapy treatment is well
  • documented and that the anemia is not due to other causes
  • It is essential to include relevant lab results and treatment history in the documentation

Exclusion Criteria

Do NOT use D64.81 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

36430CPT Code

Transfusion of red blood cells

Clinical Scenario

Used when a patient with D64.81 requires a blood transfusion due to severe anemia.

Documentation Requirements

Document the indication for transfusion and patient response.

Specialty Considerations

Oncology specialists should note the patient's chemotherapy history.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of anemia types, including those due to chemotherapy, improving the accuracy of patient records and reimbursement processes. D64.81 provides a clear link between the treatment and the resulting condition, facilitating better patient management and care.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of anemia types, including those due to chemotherapy, improving the accuracy of patient records and reimbursement processes. D64.81 provides a clear link between the treatment and the resulting condition, facilitating better patient management and care.

Reimbursement & Billing Impact

reimbursement processes. D64.81 provides a clear link between the treatment and the resulting condition, facilitating better patient management and 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 documentation is required to support the use of D64.81?

Documentation must include the patient's chemotherapy treatment history, lab results indicating anemia, and any related clinical findings. It is essential to link the anemia directly to the chemotherapy received.