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v1.0.0
ICD-10 Guide
ICD-10 CodesD64.9

D64.9

Billable

Anemia, unspecified

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

Code Description

ICD-10 D64.9 is a billable code used to indicate a diagnosis of anemia, unspecified.

Key Diagnostic Point:

Anemia is a condition characterized by a deficiency in the number or quality of red blood cells, leading to reduced oxygen transport in the body. The unspecified nature of this code indicates that the specific type of anemia has not been determined. Aplastic anemia, a form of bone marrow failure, is a critical consideration as it results in the inadequate production of blood cells due to damage to the bone marrow. Acquired anemias can arise from various factors, including nutritional deficiencies (like iron, vitamin B12, or folate), chronic diseases, or exposure to toxins. Hematopoietic disorders encompass a range of conditions affecting blood cell production, including leukemias and lymphomas, which may also lead to anemia. Accurate diagnosis is essential, as treatment varies significantly based on the underlying cause. Clinicians must conduct thorough evaluations, including blood tests and bone marrow biopsies, to identify the specific type of anemia, which can guide appropriate management strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes for anemia
  • Need for detailed clinical documentation to specify type
  • Potential overlap with other hematologic disorders
  • Variability in treatment approaches based on etiology

Audit Risk Factors

  • Insufficient documentation of anemia type
  • Failure to link anemia to underlying conditions
  • Inconsistent coding practices among providers
  • Lack of follow-up documentation for chronic cases

Specialty Focus

Medical Specialties

Hematology

Documentation Requirements

Detailed lab results, patient history, and treatment plans must be documented.

Common Clinical Scenarios

Diagnosis and management of various types of anemia, including aplastic anemia and iron deficiency anemia.

Billing Considerations

Hematologists must ensure that the specific type of anemia is documented to avoid unspecified coding.

Primary Care

Documentation Requirements

Comprehensive patient history, physical examination findings, and lab results.

Common Clinical Scenarios

Routine screening for anemia in patients with chronic diseases or nutritional deficiencies.

Billing Considerations

Primary care providers should document any referrals to specialists for further evaluation.

Coding Guidelines

Inclusion Criteria

Use D64.9 When
  • According to ICD
  • 10 coding guidelines, D64
  • 9 should be used when the type of anemia is not specified
  • Coders must ensure that the documentation supports the diagnosis and that any underlying conditions are also coded appropriately

Exclusion Criteria

Do NOT use D64.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

85025CPT Code

Complete blood count (CBC) with automated differential

Clinical Scenario

Used to evaluate anemia in patients presenting with fatigue.

Documentation Requirements

Document the reason for the CBC and any relevant patient history.

Specialty Considerations

Hematologists may require additional tests based on CBC results.

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, improving the accuracy of data collection and reimbursement processes. However, the use of unspecified codes like D64.9 may lead to increased scrutiny during audits.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of anemia types, improving the accuracy of data collection and reimbursement processes. However, the use of unspecified codes like D64.9 may lead to increased scrutiny during audits.

Reimbursement & Billing Impact

reimbursement processes. However, the use of unspecified codes like D64.9 may lead to increased scrutiny during audits.

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

When should I use D64.9?

Use D64.9 when the type of anemia is not specified in the documentation, and ensure that the clinical context supports this coding choice.