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v1.0.0
ICD-10 Guide
ICD-10 CodesD56.1

D56.1

Billable

Beta thalassemia

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

Code Description

ICD-10 D56.1 is a billable code used to indicate a diagnosis of beta thalassemia.

Key Diagnostic Point:

Beta thalassemia is a genetic blood disorder characterized by reduced production of hemoglobin due to mutations in the HBB gene on chromosome 11. This condition leads to ineffective erythropoiesis and hemolytic anemia, resulting in symptoms such as fatigue, pallor, and splenomegaly. Patients may experience varying degrees of severity, with beta thalassemia minor typically presenting with mild anemia and beta thalassemia major (Cooley's anemia) leading to severe anemia requiring regular blood transfusions. The condition is prevalent in populations from the Mediterranean region, the Middle East, and Southeast Asia. Diagnosis is confirmed through hemoglobin electrophoresis, which reveals abnormal hemoglobin patterns. Management includes regular monitoring, blood transfusions, iron chelation therapy to prevent iron overload, and in some cases, hematopoietic stem cell transplantation. Genetic counseling is recommended for affected families to understand inheritance patterns and reproductive options.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Genetic testing and family history documentation requirements
  • Differentiation between beta thalassemia minor and major
  • Potential for co-existing hemolytic anemias
  • Need for comprehensive patient history to assess severity

Audit Risk Factors

  • Inadequate documentation of genetic testing results
  • Failure to specify the type of beta thalassemia
  • Misclassification of severity leading to incorrect coding
  • Lack of family history documentation

Specialty Focus

Medical Specialties

Hematology

Documentation Requirements

Detailed lab results, genetic testing, and treatment plans.

Common Clinical Scenarios

Management of patients with beta thalassemia major requiring transfusions.

Billing Considerations

Ensure documentation reflects the severity and type of thalassemia for accurate coding.

Genetics

Documentation Requirements

Family history, genetic test results, and counseling notes.

Common Clinical Scenarios

Genetic counseling for families with a history of thalassemia.

Billing Considerations

Document inheritance patterns and potential risks for offspring.

Coding Guidelines

Inclusion Criteria

Use D56.1 When
  • Follow ICD
  • CM guidelines for coding genetic disorders and hemolytic anemias
  • Ensure accurate documentation of the type and severity of beta thalassemia
  • Include any related conditions that may affect treatment

Exclusion Criteria

Do NOT use D56.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

85025CPT Code

Complete blood count (CBC) with differential

Clinical Scenario

Used to monitor hemoglobin levels in patients with beta thalassemia.

Documentation Requirements

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

Specialty Considerations

Hematology specialists should ensure accurate interpretation of results.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of beta thalassemia, improving the ability to capture the nuances of the condition and its management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of beta thalassemia, improving the ability to capture the nuances of the condition and its management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of beta thalassemia, improving the ability to capture the nuances of the condition and its management.

Resources

Clinical References

  • •
    National Heart, Lung, and Blood Institute - Thalassemia

Coding & Billing References

  • •
    National Heart, Lung, and Blood Institute - Thalassemia

Frequently Asked Questions

What is the difference between beta thalassemia minor and major?

Beta thalassemia minor typically presents with mild anemia and may not require treatment, while beta thalassemia major leads to severe anemia and requires regular blood transfusions and management of complications.