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ICD-10 Guide
ICD-10 CodesD61.3

D61.3

Billable

Idiopathic aplastic anemia

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

Code Description

ICD-10 D61.3 is a billable code used to indicate a diagnosis of idiopathic aplastic anemia.

Key Diagnostic Point:

Idiopathic aplastic anemia is a rare hematological disorder characterized by the failure of the bone marrow to produce adequate amounts of blood cells, leading to pancytopenia (a reduction in red blood cells, white blood cells, and platelets). The term 'idiopathic' indicates that the exact cause of the condition is unknown, although it may be associated with autoimmune disorders, exposure to certain chemicals, drugs, or viral infections. Patients typically present with symptoms such as fatigue, increased susceptibility to infections, and easy bruising or bleeding due to low platelet counts. Diagnosis is confirmed through blood tests showing low blood cell counts and a bone marrow biopsy revealing hypocellular marrow. Treatment options may include immunosuppressive therapy, bone marrow transplantation, or supportive care, depending on the severity of the condition and the patient's overall health. The management of idiopathic aplastic anemia requires a multidisciplinary approach, often involving hematologists and other specialists to monitor and treat complications effectively.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other types of anemia and bone marrow failure syndromes
  • Need for comprehensive documentation of symptoms and lab results
  • Potential for overlapping diagnoses with other hematological disorders
  • Variability in treatment approaches and patient responses

Audit Risk Factors

  • Inadequate documentation of symptoms and lab findings
  • Failure to specify the idiopathic nature of the condition
  • Misclassification with other types of anemia
  • Lack of follow-up documentation for ongoing treatment

Specialty Focus

Medical Specialties

Hematology

Documentation Requirements

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

Common Clinical Scenarios

Diagnosis confirmation, treatment initiation, and monitoring of treatment response.

Billing Considerations

Ensure that all relevant lab values and clinical symptoms are documented to support the diagnosis.

Oncology

Documentation Requirements

Comprehensive treatment history, including any chemotherapy or radiation therapy that may affect bone marrow function.

Common Clinical Scenarios

Management of patients with aplastic anemia who have a history of malignancy.

Billing Considerations

Document any potential secondary causes of aplastic anemia related to cancer treatment.

Coding Guidelines

Inclusion Criteria

Use D61.3 When
  • According to ICD
  • 10 coding guidelines, D61
  • 3 should be used when the aplastic anemia is confirmed to be idiopathic
  • Coders must ensure that the diagnosis is supported by clinical documentation, including lab results and any relevant history

Exclusion Criteria

Do NOT use D61.3 When
  • Exclusion of other causes of aplastic anemia is essential

Related ICD-10 Codes

Related CPT Codes

85025CPT Code

Complete blood count (CBC) with differential

Clinical Scenario

Used to monitor blood cell levels in patients with aplastic anemia.

Documentation Requirements

Document the reason for the CBC and any relevant findings.

Specialty Considerations

Hematologists should ensure that CBC results are interpreted in the context of the patient's clinical status.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of idiopathic aplastic anemia, improving the accuracy of data collection and reimbursement processes. The detailed coding structure helps in better tracking of patient outcomes and treatment efficacy.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of idiopathic aplastic anemia, improving the accuracy of data collection and reimbursement processes. The detailed coding structure helps in better tracking of patient outcomes and treatment efficacy.

Reimbursement & Billing Impact

reimbursement processes. The detailed coding structure helps in better tracking of patient outcomes and treatment efficacy.

Resources

Clinical References

  • •
    American Society of Hematology

Coding & Billing References

  • •
    American Society of Hematology

Frequently Asked Questions

What is the primary cause of idiopathic aplastic anemia?

The primary cause of idiopathic aplastic anemia is unknown, but it may be associated with autoimmune processes, environmental factors, or viral infections.

How is idiopathic aplastic anemia diagnosed?

Diagnosis is made through clinical evaluation, blood tests showing low blood cell counts, and a bone marrow biopsy that reveals hypocellular marrow.

What are the treatment options for idiopathic aplastic anemia?

Treatment options include immunosuppressive therapy, bone marrow transplantation, and supportive care, depending on the severity of the condition.