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ICD-10 Guide
ICD-10 CodesD61.01

D61.01

Billable

Constitutional (pure) red blood cell aplasia

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

Code Description

ICD-10 D61.01 is a billable code used to indicate a diagnosis of constitutional (pure) red blood cell aplasia.

Key Diagnostic Point:

Constitutional (pure) red blood cell aplasia is a rare hematological disorder characterized by the selective failure of erythropoiesis, leading to a significant reduction in red blood cell production. This condition is often congenital and can be associated with genetic mutations affecting erythroid progenitor cells in the bone marrow. Patients typically present with symptoms of anemia, including fatigue, pallor, and shortness of breath. The diagnosis is confirmed through bone marrow biopsy, which reveals a marked reduction or absence of erythroid precursors while other hematopoietic lineages remain intact. Aplastic anemia, a broader category that includes various forms of bone marrow failure, can also lead to red blood cell aplasia but is distinguished by the involvement of multiple blood cell lineages. Treatment options may include supportive care, erythropoietin-stimulating agents, and in severe cases, bone marrow transplantation. Understanding the underlying causes and appropriate management strategies is crucial for improving patient outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other types of anemia, such as aplastic anemia and secondary anemias.
  • Need for precise documentation of laboratory findings and bone marrow biopsy results.
  • Potential overlap with other hematological disorders requiring careful clinical assessment.
  • Variability in presentation and severity among patients, necessitating individualized coding.

Audit Risk Factors

  • Inadequate documentation of laboratory results and clinical findings.
  • Misclassification of anemia types leading to incorrect coding.
  • Failure to document the patient's response to treatment.
  • Lack of clarity in distinguishing between congenital and acquired forms.

Specialty Focus

Medical Specialties

Hematology

Documentation Requirements

Detailed lab results, bone marrow biopsy reports, and treatment plans.

Common Clinical Scenarios

Diagnosis of constitutional red blood cell aplasia in pediatric patients, management of anemia in adults.

Billing Considerations

Ensure accurate differentiation from other hematological disorders and document any genetic testing results.

Pediatrics

Documentation Requirements

Growth and developmental assessments, family history of hematological disorders.

Common Clinical Scenarios

Evaluation of anemic children with suspected congenital disorders.

Billing Considerations

Consider the implications of genetic counseling and family history in coding.

Coding Guidelines

Inclusion Criteria

Use D61.01 When
  • According to ICD
  • 10 guidelines, D61
  • 01 should be used when there is clear documentation of constitutional red blood cell aplasia

Exclusion Criteria

Do NOT use D61.01 When
  • It is essential to exclude other causes of anemia and ensure that the diagnosis is supported by appropriate clinical and laboratory findings

Related ICD-10 Codes

Related CPT Codes

85025CPT Code

Complete blood count (CBC) with differential

Clinical Scenario

Used to evaluate anemia severity and monitor treatment response.

Documentation Requirements

Document the reason for the CBC and any relevant findings.

Specialty Considerations

Hematologists should ensure that the CBC is interpreted in the context of the patient's overall clinical picture.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of hematological disorders, including D61.01, which provides better data for epidemiological studies and treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of hematological disorders, including D61.01, which provides better data for epidemiological studies and treatment outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of hematological disorders, including D61.01, which provides better data for epidemiological studies and treatment outcomes.

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 is the primary cause of constitutional red blood cell aplasia?

Constitutional red blood cell aplasia is primarily caused by genetic mutations affecting erythroid progenitor cells in the bone marrow, leading to a failure in red blood cell production.