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ICD-10 Guide
ICD-10 CodesD56.9

D56.9

Billable

Thalassemia, unspecified

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

Code Description

ICD-10 D56.9 is a billable code used to indicate a diagnosis of thalassemia, unspecified.

Key Diagnostic Point:

Thalassemia is a group of inherited blood disorders characterized by reduced or absent synthesis of hemoglobin chains, leading to ineffective erythropoiesis and hemolytic anemia. The condition is primarily caused by genetic mutations affecting the alpha or beta globin genes, resulting in an imbalance in globin chain production. Patients with thalassemia may present with symptoms such as fatigue, pallor, and splenomegaly due to chronic hemolysis. The severity of thalassemia can vary widely, from asymptomatic carriers to individuals with severe anemia requiring regular blood transfusions. Diagnosis is typically confirmed through hemoglobin electrophoresis, complete blood count (CBC), and genetic testing. Management may include regular monitoring, blood transfusions, iron chelation therapy, and in some cases, hematopoietic stem cell transplantation. The unspecified nature of this code indicates that the specific type of thalassemia (alpha or beta) has not been determined, which can complicate treatment and management strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of thalassemia.
  • Need for genetic testing to confirm diagnosis.
  • Differentiation from other hemolytic anemias.
  • Potential for co-existing conditions affecting management.

Audit Risk Factors

  • Inadequate documentation of laboratory results.
  • Failure to specify the type of thalassemia when known.
  • Misclassification with other types of anemia.
  • Lack of genetic testing documentation.

Specialty Focus

Medical Specialties

Hematology

Documentation Requirements

Detailed lab results, family history, and treatment plans.

Common Clinical Scenarios

Management of patients with varying severity of thalassemia, including transfusion protocols.

Billing Considerations

Thorough documentation of hemoglobin levels and response to treatment is crucial.

Genetics

Documentation Requirements

Genetic testing results and family pedigree charts.

Common Clinical Scenarios

Counseling patients and families about inheritance patterns and risks.

Billing Considerations

Documentation of genetic counseling sessions and recommendations for family testing.

Coding Guidelines

Inclusion Criteria

Use D56.9 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation
  • Include any relevant lab results and genetic testing outcomes

Exclusion Criteria

Do NOT use D56.9 When
  • Exclude conditions that are specifically coded elsewhere

Related ICD-10 Codes

Related CPT Codes

85025CPT Code

Complete blood count (CBC) with differential

Clinical Scenario

Used to evaluate anemia in patients suspected of having thalassemia.

Documentation Requirements

Document the reason for the CBC and any relevant findings.

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 thalassemia types, improving data accuracy and treatment tracking. However, the unspecified code D56.9 may lead to challenges in treatment planning and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of thalassemia types, improving data accuracy and treatment tracking. However, the unspecified code D56.9 may lead to challenges in treatment planning and reimbursement.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    Thalassemia International Federation

Coding & Billing References

  • •
    Thalassemia International Federation

Frequently Asked Questions

What is the difference between alpha and beta thalassemia?

Alpha thalassemia results from mutations in the alpha globin genes, while beta thalassemia is due to mutations in the beta globin genes. The clinical manifestations and severity can differ significantly between the two types.