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ICD-10 Guide
ICD-10 CodesD81.0

D81.0

Billable

Severe combined immunodeficiency [SCID] with reticular dysgenesis

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

Code Description

ICD-10 D81.0 is a billable code used to indicate a diagnosis of severe combined immunodeficiency [scid] with reticular dysgenesis.

Key Diagnostic Point:

Severe combined immunodeficiency (SCID) with reticular dysgenesis is a rare genetic disorder characterized by a profound deficiency in both T-lymphocyte and B-lymphocyte function, leading to a severely compromised immune system. This condition is often caused by mutations in genes critical for lymphocyte development, particularly affecting the bone marrow's ability to produce these immune cells. Reticular dysgenesis is the most severe form of SCID, where there is a failure of hematopoiesis, resulting in the absence of all types of blood cells, including red blood cells, white blood cells, and platelets. Patients typically present in infancy with recurrent infections, failure to thrive, and may exhibit signs of severe anemia or bleeding due to thrombocytopenia. Without intervention, such as hematopoietic stem cell transplantation, affected individuals face a high risk of mortality from opportunistic infections. Early diagnosis through newborn screening and genetic testing is crucial for effective management and improving outcomes.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Requires understanding of genetic disorders and their implications.
  • Involves multiple organ systems and potential complications.
  • Differentiation from other immunodeficiencies is necessary.
  • Documentation must include specific laboratory findings and genetic testing results.

Audit Risk Factors

  • Inadequate documentation of genetic testing results.
  • Failure to specify the severity of immunodeficiency.
  • Misclassification with other types of SCID or immunodeficiencies.
  • Lack of clear linkage between clinical findings and the diagnosis.

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed history of recurrent infections, growth parameters, and laboratory results.

Common Clinical Scenarios

Infants presenting with failure to thrive and recurrent infections.

Billing Considerations

Documentation must clearly outline the severity and specific immunological deficits.

Hematology

Documentation Requirements

Complete blood counts, bone marrow biopsy results, and genetic testing documentation.

Common Clinical Scenarios

Patients with unexplained cytopenias and recurrent infections.

Billing Considerations

Focus on hematopoietic function and the need for potential stem cell transplantation.

Coding Guidelines

Inclusion Criteria

Use D81.0 When
  • Follow the official ICD
  • CM coding guidelines for coding genetic disorders and immunodeficiencies
  • Ensure that documentation supports the diagnosis, including laboratory findings and clinical symptoms

Exclusion Criteria

Do NOT use D81.0 When
  • Exclude conditions that do not meet the criteria for SCID

Related ICD-10 Codes

Related CPT Codes

38220CPT Code

Bone marrow aspiration

Clinical Scenario

Used for diagnosis and monitoring of hematologic conditions in SCID patients.

Documentation Requirements

Document indications for aspiration and findings.

Specialty Considerations

Hematology specialists should ensure accurate coding based on findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of immunodeficiencies, improving the ability to capture the complexity of conditions like SCID with reticular dysgenesis. This specificity aids in better patient management and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of immunodeficiencies, improving the ability to capture the complexity of conditions like SCID with reticular dysgenesis. This specificity aids in better patient management and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of immunodeficiencies, improving the ability to capture the complexity of conditions like SCID with reticular dysgenesis. This specificity aids in better patient management and resource allocation.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Immunodeficiency

Coding & Billing References

  • •
    American Academy of Pediatrics - Immunodeficiency

Frequently Asked Questions

What are the common symptoms of SCID with reticular dysgenesis?

Common symptoms include recurrent infections, failure to thrive, and signs of severe anemia or bleeding due to low blood cell counts.

How is SCID diagnosed?

Diagnosis is typically made through newborn screening tests, followed by genetic testing and immunological assays to confirm the absence of functional lymphocytes.