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ICD-10 Guide
ICD-10 CodesP61.3

P61.3

Billable

Congenital anemia from fetal blood loss

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 P61.3 is a billable code used to indicate a diagnosis of congenital anemia from fetal blood loss.

Key Diagnostic Point:

Congenital anemia from fetal blood loss is a condition characterized by a decrease in red blood cell mass due to blood loss that occurs in utero. This can result from various factors, including placental abruption, twin-to-twin transfusion syndrome, or maternal hemorrhage. The condition can lead to significant morbidity in neonates, including hypoxia, organ dysfunction, and increased risk of neonatal intensive care unit (NICU) admission. Diagnosis is typically made through clinical evaluation, laboratory tests showing low hemoglobin levels, and imaging studies to assess for underlying causes of fetal blood loss. Management may involve intrauterine transfusions, postnatal transfusions, and supportive care in the NICU. Early recognition and intervention are crucial to improving outcomes for affected infants.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between types of anemia and their causes
  • Understanding the implications of fetal blood loss on neonatal health
  • Navigating associated conditions such as thrombocytopenia and polycythemia
  • Documentation requirements for accurate coding

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify the cause of anemia
  • Misclassification of anemia types
  • Inconsistent coding of associated conditions

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed records of hemoglobin levels, transfusion history, and clinical assessments.

Common Clinical Scenarios

Neonates presenting with pallor, lethargy, or respiratory distress requiring NICU admission.

Billing Considerations

Accurate coding requires understanding of the underlying causes of anemia and associated complications.

Pediatrics

Documentation Requirements

Comprehensive history and physical examination notes, including maternal health history.

Common Clinical Scenarios

Pediatric follow-up for infants with a history of congenital anemia, monitoring growth and development.

Billing Considerations

Consideration of long-term outcomes and potential developmental delays in affected infants.

Coding Guidelines

Inclusion Criteria

Use P61.3 When
  • Follow the ICD
  • CM guidelines for coding congenital conditions, ensuring specificity in documentation regarding the cause of anemia and any associated conditions

Exclusion Criteria

Do NOT use P61.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

36430CPT Code

Transfusion of blood products

Clinical Scenario

Used when a newborn with P61.3 requires blood transfusions due to severe anemia.

Documentation Requirements

Document the indication for transfusion, type of blood product, and patient response.

Specialty Considerations

Neonatologists must ensure compliance with transfusion protocols and monitor for adverse reactions.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of congenital conditions, improving the accuracy of data collection and reimbursement processes for neonatal care.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital conditions, improving the accuracy of data collection and reimbursement processes for neonatal care.

Reimbursement & Billing Impact

reimbursement processes for neonatal care.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Neonatal Anemia Guidelines

Coding & Billing References

  • •
    American Academy of Pediatrics - Neonatal Anemia Guidelines

Frequently Asked Questions

What are the common causes of congenital anemia from fetal blood loss?

Common causes include maternal hemorrhage, placental abruption, and twin-to-twin transfusion syndrome. Each of these conditions can lead to significant fetal blood loss, resulting in anemia.