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ICD-10 Guide
ICD-10 CodesD61.9

D61.9

Billable

Aplastic anemia, unspecified

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

Code Description

ICD-10 D61.9 is a billable code used to indicate a diagnosis of aplastic anemia, unspecified.

Key Diagnostic Point:

Aplastic anemia is a rare but serious hematologic 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). This condition can be either inherited or acquired, with acquired aplastic anemia being more common. The causes of acquired aplastic anemia can include exposure to certain chemicals (like benzene), radiation, viral infections (such as hepatitis or Epstein-Barr virus), and autoimmune diseases. Patients may present with symptoms such as fatigue, increased susceptibility to infections, and easy bruising or bleeding due to low platelet counts. Diagnosis typically involves blood tests and a bone marrow biopsy to assess the cellularity of the marrow. Treatment options vary based on the severity of the condition and may include immunosuppressive therapy, bone marrow transplantation, or supportive care. The unspecified nature of this code indicates that the specific etiology or severity of the aplastic anemia has not been documented, which can complicate treatment and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of the condition.
  • Need for detailed documentation to specify the cause of aplastic anemia.
  • Differentiation from other types of anemia and hematologic disorders.
  • Potential for overlapping symptoms with other conditions.

Audit Risk Factors

  • Insufficient documentation of the patient's history and symptoms.
  • Failure to specify the cause of aplastic anemia.
  • Inadequate laboratory results to support the diagnosis.
  • Misclassification of the severity of the condition.

Specialty Focus

Medical Specialties

Hematology

Documentation Requirements

Detailed patient history, laboratory results, and treatment plans.

Common Clinical Scenarios

Diagnosis and management of patients with unexplained anemia, evaluation of bone marrow function.

Billing Considerations

Need for precise documentation of laboratory findings and treatment responses.

Oncology

Documentation Requirements

Comprehensive cancer history, treatment regimens, and response assessments.

Common Clinical Scenarios

Management of aplastic anemia in patients undergoing chemotherapy or radiation therapy.

Billing Considerations

Consideration of the impact of cancer treatments on bone marrow function.

Coding Guidelines

Inclusion Criteria

Use D61.9 When
  • According to ICD
  • 10 guidelines, D61
  • 9 should be used when the specific cause of aplastic anemia is not documented
  • Coders should ensure that all relevant clinical information is captured to support the diagnosis

Exclusion Criteria

Do NOT use D61.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

85025CPT Code

Complete blood count (CBC) with differential

Clinical Scenario

Used to evaluate blood cell counts in patients suspected of having aplastic anemia.

Documentation Requirements

Document the reason for the CBC and any relevant clinical 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 hematologic disorders, including aplastic anemia. D61.9 provides a clear designation for unspecified cases, but it also emphasizes the need for thorough documentation to support the diagnosis and treatment.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of hematologic disorders, including aplastic anemia. D61.9 provides a clear designation for unspecified cases, but it also emphasizes the need for thorough documentation to support the diagnosis and treatment.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of hematologic disorders, including aplastic anemia. D61.9 provides a clear designation for unspecified cases, but it also emphasizes the need for thorough documentation to support the diagnosis and treatment.

Resources

Clinical References

  • •
    Aplastic Anemia and MDS International Foundation

Coding & Billing References

  • •
    Aplastic Anemia and MDS International Foundation

Frequently Asked Questions

What is the difference between aplastic anemia and other types of anemia?

Aplastic anemia is characterized by bone marrow failure leading to a decrease in all blood cell types, while other types of anemia, such as iron deficiency anemia, are typically due to specific deficiencies or chronic diseases affecting red blood cell production.