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ICD-10 Guide
ICD-10 CodesP61.4

P61.4

Billable

Other congenital anemias, not elsewhere classified

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 P61.4 is a billable code used to indicate a diagnosis of other congenital anemias, not elsewhere classified.

Key Diagnostic Point:

Congenital anemias are a group of hematological disorders characterized by a deficiency in red blood cells or hemoglobin, leading to reduced oxygen transport in the body. The code P61.4 specifically refers to congenital anemias that do not fall under more specific classifications. These conditions can arise from various genetic factors, nutritional deficiencies, or environmental influences. In neonates, congenital anemias may present with symptoms such as pallor, lethargy, and poor feeding. Diagnosis often involves a complete blood count (CBC), reticulocyte count, and specific tests to identify the underlying cause. Management may include blood transfusions, iron supplementation, or treatment of the underlying condition. It is crucial for healthcare providers to monitor these infants closely, as untreated anemia can lead to significant morbidity and developmental delays.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes leading to anemia
  • Need for comprehensive laboratory testing to determine specific type of anemia
  • Differentiation from other hematological disorders such as thrombocytopenia and polycythemia
  • Potential for co-existing conditions that complicate diagnosis and treatment

Audit Risk Factors

  • Inadequate documentation of laboratory results
  • Failure to specify the type of anemia
  • Misclassification of anemia type leading to incorrect coding
  • Lack of follow-up documentation on treatment outcomes

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed clinical notes including gestational age, birth weight, and specific laboratory findings are essential for accurate coding.

Common Clinical Scenarios

Neonates presenting with jaundice and anemia requiring NICU admission for management.

Billing Considerations

Consideration of maternal health factors and prenatal history that may contribute to anemia in the newborn.

Pediatrics

Documentation Requirements

Pediatric documentation should include growth parameters and developmental assessments alongside hematological evaluations.

Common Clinical Scenarios

Pediatric patients with a history of congenital anemia presenting for routine follow-up or complications.

Billing Considerations

Awareness of the long-term implications of congenital anemia on growth and development.

Coding Guidelines

Inclusion Criteria

Use P61.4 When
  • Follow the official ICD
  • CM guidelines for coding congenital conditions, ensuring that all relevant clinical information is documented
  • Specific criteria for anemia diagnosis must be met, including laboratory confirmation

Exclusion Criteria

Do NOT use P61.4 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

36430CPT Code

Transfusion of blood products

Clinical Scenario

Used in cases of severe congenital anemia requiring immediate intervention.

Documentation Requirements

Document the indication for transfusion, type of blood product, and patient response.

Specialty Considerations

Neonatologists must ensure proper consent and monitoring during transfusion.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of congenital anemias, improving the ability to track and manage these conditions in neonates. It emphasizes the need for detailed clinical documentation to support the diagnosis.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital anemias, improving the ability to track and manage these conditions in neonates. It emphasizes the need for detailed clinical documentation to support the diagnosis.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of congenital anemias, improving the ability to track and manage these conditions in neonates. It emphasizes the need for detailed clinical documentation to support the diagnosis.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Guidelines for Coding and Billing

Coding & Billing References

  • •
    American Academy of Pediatrics - Guidelines for Coding and Billing

Frequently Asked Questions

What are the common causes of congenital anemia in neonates?

Common causes include genetic disorders such as thalassemia and sickle cell disease, as well as environmental factors like maternal nutritional deficiencies during pregnancy.