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ICD-10 Guide
ICD-10 CodesD64.1

D64.1

Billable

Secondary sideroblastic anemia due to disease

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

Code Description

ICD-10 D64.1 is a billable code used to indicate a diagnosis of secondary sideroblastic anemia due to disease.

Key Diagnostic Point:

Secondary sideroblastic anemia is a type of anemia characterized by the presence of ringed sideroblasts in the bone marrow, which are erythroblasts that contain iron granules. This condition arises due to underlying diseases that affect hemoglobin synthesis, leading to ineffective erythropoiesis. Common causes include chronic inflammatory diseases, malignancies, and exposure to certain drugs or toxins. In patients with secondary sideroblastic anemia, the bone marrow fails to produce adequate healthy red blood cells, resulting in symptoms such as fatigue, weakness, pallor, and shortness of breath. The diagnosis is typically confirmed through a combination of blood tests, bone marrow biopsy, and iron studies. Treatment focuses on managing the underlying condition, which may involve the use of medications, blood transfusions, or iron chelation therapy. Understanding the etiology and pathophysiology of this anemia is crucial for effective management and coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between primary and secondary causes of sideroblastic anemia.
  • Understanding the various underlying diseases that can lead to this condition.
  • The need for comprehensive documentation of the underlying disease.
  • Potential overlap with other types of anemia codes.

Audit Risk Factors

  • Inadequate documentation of the underlying disease.
  • Failure to specify the type of sideroblastic anemia.
  • Misclassification of anemia type.
  • Lack of supporting lab results in the medical record.

Specialty Focus

Medical Specialties

Hematology

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with fatigue and pallor, requiring evaluation for anemia.

Billing Considerations

Ensure that all lab findings and underlying conditions are clearly documented to support the diagnosis.

Oncology

Documentation Requirements

Oncology treatment history, including chemotherapy regimens and response to treatment.

Common Clinical Scenarios

Patients with malignancies who develop anemia as a complication of their disease or treatment.

Billing Considerations

Document the relationship between the malignancy and the development of sideroblastic anemia.

Coding Guidelines

Inclusion Criteria

Use D64.1 When
  • According to ICD
  • 10 guidelines, D64
  • 1 should be used when sideroblastic anemia is confirmed to be secondary to another disease
  • Coders must ensure that the underlying condition is documented and coded appropriately

Exclusion Criteria

Do NOT use D64.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

85025CPT Code

Complete blood count (CBC) with differential

Clinical Scenario

Used to evaluate anemia and monitor treatment response.

Documentation Requirements

Document the reason for the CBC and any relevant clinical findings.

Specialty Considerations

Hematologists should ensure that all relevant lab results are included in the patient's record.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of anemia types, including secondary sideroblastic anemia. This specificity aids in better tracking of patient outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of anemia types, including secondary sideroblastic anemia. This specificity aids in better tracking of patient outcomes and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of anemia types, including secondary sideroblastic anemia. This specificity aids in better tracking of patient outcomes and resource allocation.

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 difference between primary and secondary sideroblastic anemia?

Primary sideroblastic anemia is a genetic disorder, while secondary sideroblastic anemia is caused by other diseases or conditions that affect red blood cell production.