Basic ICD-10-CM Coding 2013 Edition

1. Basic ICD-10-CM Coding2013 Edition Chapter 6: Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism (D50–D89)

2. Learning Objectives • Review the chapter’s learning objectives and key terms • At the conclusion of this chapter, what must you know about the coding of diseases of blood and blood-forming organs and certain disorders involving the immune mechanism?

3. ICD-10-CM Chapter 3 Chapter 3 of ICD-10-CM, Diseases of Blood and Blood-forming Organs and Certain Disorders Involving the Immune System, D50–D89 Contains codes for nutritional, hemolytic, aplastic, and acquired anemias as well as purpura, coagulation defects, and other disorders Immunodeficiency disorders moved to this chapter in ICD-10-CM

4. ICD-10-CM Chapter 3 Organization and Structure D50–D53: Nutritional anemias D55–D59: Hemolytic anemias D60–D64: Aplastic and other anemias and other bone marrow failure syndromes D65–D69: Coagulation defects, purpura and other hemorrhagic conditions D70–D77: Other disorders of blood and blood-forming organs D78: Intraoperative and postprocedural complications of spleen D80–D89: Certain disorders involving the immune mechanism

5. ICD-10-CM Coding Guidelines Chapter 3 In the 2013 edition of the ICD-10-CM Coding Guidelines there are no guidelines for Chapter 3. The document states that part of the guidelines are reserved for future guideline expansion for these conditions.

6. ICD-10-CM Instructional Notes, Chapter 3 Instructional notes with certain anemia codes instructs the coder to use an additional code for adverse effects, if applicable, to identify drug (T36–T50) with the fifth or sixth character 5. Another note found in this chapter is code first, if applicable, toxic effects of substances chiefly nonmedicinal as to source (T51–T65.)

7. ICD-10-CM Instructional Notes, Chapter 3 Two instructional notes appear with a code if the type of anemia is produced by either a poisoning or an adverse effect of a drug, such as Code first poisoning due to drug or toxin, if applicable (T36–T65), with fifth or sixth character 1–4 or 6 Use additional code for adverse effect, if applicable, to identify drug (T36–T50) with fifth or sixth character 5

8. ICD-10-CM Instructional Notes, Chapter 3 Other instructional notes apply to the entire category or codes or an individual code is to use additional codes for associated conditions. For example: Use additional code, if applicable, for hydrops fetalis due to alpha thalassemia (P56.99) Use additional code for any associated fever (R50.81) Use additional code to identify associated condition

9. ICD-10-CM Instructional Notes, Chapter 3 Instructions are included to code first or code also the underlying disease With certain blood disorders, there are notes to use additional code to identify external cause Certain blood disorders and disorders involving the immune mechanism are related to underlying diseases as well as influences of drugs and toxins. In addition, a blood disorder can produce other conditions or manifestations

10. ICD-10-CM Coding Guidelines from Other Chapters Coding guideline for Chapter 2 does apply to conditions in this chapter: When admission or encounter is for management of an anemia associated with the malignancy, and the treatment is only for anemia, the appropriate code for the malignancy is sequenced first followed by code for the anemia (such as D63.0, Anemia in neoplasticdisease)

11. ICD-10-CM Coding Guidelines from Other Chapters There are directions in the guidelines for anemia with chemotherapy, immunotherapy, and radiation therapy

12. ICD-10-CM Coding Guidelines from Other Chapters For example, when the patient is seen for management of anemia associated with an adverse effect of the administration of chemotherapy or immunotherapy and the only treatment is for the anemia, the following should be coded: 1. The type of anemia treated and sequenced first 2. The neoplasm being treated with chemo- or immunotherapy 3. The adverse effect (T45.1X5) of antineoplastic and immunosuppressive drugs

13. ICD-10-CM Coding Guidelines from Other Chapters Another example is when the patient is seen for management of anemia associated with an adverse effect of radiation, the following should be coded: 1. The type of anemia treated and sequenced first 2. The neoplasm being treated with radiation therapy 3. Y84.2, Radiological procedure and radiotherapy as the cause of abnormal reaction of the patient, of or later complication, without mention of misadventure at the time of the procedure

14. Diseases in Chapter 3 Diseases within Chapter 3 include anemias, coagulation defects, purpura, and other hemorrhagic disorders as well as a variety of other disorders of blood-forming organs Anemia is a decrease in the number of erythrocytes (red blood cells), the quantity of hemoglobin, or the volume of packed red cells in the blood Nutritional anemias include iron deficiency, vitamin B12 deficiency, pernicious anemia, folate deficiency, protein deficiency, megaloblastic and simple chronic anemia

15. Diseases in Chapter 3 Hemolytic anemia is a condition that occurs when the bone marrow cannot make enough new red blood cells (RBCs) to replace others that are destroyed too early. Hemolytic anemias can be acquired or inherited Acquired hemolytic anemia occurs when the body destroys its RBCs before their usual lifespan is up due to a variety of causes, such as, an autoimmune response, physical damage to RBCs from certain conditions and factors, exposure to certain infectious organisms and toxins, and reactions to certain medicines.

16. Diseases in Chapter 3 Hereditary hemolytic anemia is related to problems with the genes that control how the RBCs are made in the body. This problem causes defects in the RBCs. The abnormal RBCs are fragile and break as they move through the bloodstream. Types of hereditary hemolytic anemias include: Glucose-6 phosphate dehydrogenase (G6PD) deficiency Pyruvate kinase deficiency Thalassemia Sickle cell Hereditary spherocytosis Hereditary elliptocytosis

17. Diseases in Chapter 3 Aplastic anemia is a condition in which the bone marrow is damaged. As a result, the stem cells are destroyed or develop abnormally. The body cannot make enough RBCs, WBCs, or platelets. Aplastic anemia can be acquired or inherited Known causes of acquired aplastic anemia include: High dose radiation or chemotherapy Environmental toxins Certain medicines Viral infections Autoimmune diseases From other hereditary conditions or another blood disorder

18. Diseases in Chapter 3 Acute posthemorrhagic anemia or anemia due to acute blood loss is defined as a normocytic, normochromic anemia developing as a result of rapid loss of large quantities of RBCs during bleeding. The bleeding could be the result of a spontaneous or traumatic hemorrhage in the body due to disease or trauma. Another cause may be a complication of surgery from excessive blood loss.

19. Diseases in Chapter 3 Anemia in chronic diseases develop in patients with chronic diseases, for example: Anemia in neoplastic disease Anemia in chronic kidney disease Anemia in other chronic diseases classified elsewhere

20. Diseases in Chapter 3 Coagulation defects are disorders of the platelets that result in serious bleeding due to deficiencies in one or more clotting factors Coagulation defects include Disseminated intravascular coagulation [defibrination syndrome] Hereditary factor VIII deficiency Hereditary factor IX deficiency Other coagulation defects, such as von Willebrand disease

21. Diseases in Chapter 3 Purpura and other hemorrhagic conditions are also included in Chapter 3 Thrombocytopenia is a commonly coded condition and is diagnosed when the platelets fall below 100,000/mm. Two types of thrombocytopenia are primary/idiopathic and secondary Idiopathic or immune thrombocytopenia purpura (ITP) is an autoimmune disorder with development of antibodies to one’s own platelets

22. Diseases in Chapter 3 Secondary thrombocytopenia is a complication of another disease. The treatment centers on treating the underlying disease or changing medication. Posttransfusion purpura is characterized by a sudden and severe thrombocytopenia usually occurring 5 to 10 days following blood transfusion

23. Diseases in Chapter 3 Neutropenia is a decrease in the number of neutrophils, a type of white blood cells. Other terms that describe this same disease is agranulocytosis, either the congenital type or secondary to cancer chemotherapy. There are other drug-induced agranulocytosis, neutropenia due to infection and cyclic neutropenia. Bandemia is defined as the presence of an excess number of immature WBCs or band cells, while the total WBC count is normal. Bandemia is frequently present in patients with bacterial infections. However, bandemia may be identified when a diagnosis of an infection has not been established.

24. Diseases in Chapter 3 Heparin-induced thrombocytopenia (HIT) is a life-threatening clinical event than can occur in 3 to 5 percent of all patients receiving unfractionated heparin for at least five days or in about 0.5 percent of patients receiving low molecular-weight heparin. HIT is also called a hypercoagulable state by physicians. The diagnosis is first suspected based on a fall in the platelet count by 50 percent or more occurring 5 to 12 days after beginning heparin therapy. Treatment involves the initiation of an alternative anticoagulant or direct thrombin inhibitor drugs

25. Intraoperative and Postprocedural Complications of the Spleen Category D78, Intraoperative and postprocedural complications of the spleen, includes codes for intraoperative hemorrhage and hematoma of spleen, accidental puncture and laceration of the spleen and postprocedural hemorrhage and hematoma of the spleen. The codes identify whether the complication occurred during a procedure on the spleen or the complication occurred during another surgical procedure.

26. ICD-10-PCS Procedure Coding The types of procedures most related to the treatment of blood disorders are administration of transfusions, aspiration, biopsy, and transplant procedures. Transfusions of blood and blood components is a treatment for various types of blood disorders. Transfusions are coded from the Administration section of ICD-10-PCS. The administration codes represent procedures for putting in or on a therapeutic, prophylactic, protective, diagnostic, nutritional, or physiological substance. This section includes codes for transfusions, infusions, and injections as well as irrigations.

27. ICD-10-PCS Procedure Coding Administration codes have the format Character 1 for the section uses the value 3 Character 2 is for the physiological system and anatomical region Character 3 is for the root operation with only 3 options: introduction, irrigation and transfusion Character 4 is for body system/region which identifies the site where the substance is administered Character 5 is the approach Character 6 is the substance being administered Character 7 is the qualifier—identifies if the substance is autologous, nonautologous or further specifies the substance

28. ICD-10-PCS Procedure Coding Biopsies are common procedures to diagnosis blood disorders The root operation is either drainage or excision with a seventh character qualifier of X for diagnostic Biopsies involve lymph nodes and other organs A bone marrow “biopsy” does not meet the definition of excision in ICD-10-PCS because bone marrow is not cut out. Instead a bone marrow biopsy is an “extraction” in ICD-10-PCS, that is, the bone marrow is pulled or stripped out or off by the use of force Aspirations may be performed which involves drainage or taking or letting out fluids and/or gases from a body part Aspiration of bone marrow with a seventh character qualifier of X for diagnostic

29. ICD-10-PCS Procedure Coding A bone marrow transplant is coded as a transfusion in ICD-10-PCS as it meets the definition of the root operation of transfusion, that is, putting in blood or blood products. A bone marrow transplant is a procedure to replace damaged or destroyed bone marrow with healthy bone marrow stem cells. Stem cell transplants are also coded with the root operation of transfusion. Coding of lymph node biopsy is coded to the root operation Excision or Aspiration depending on how the specimen is removed. Usually a lymph node biopsy is performed by cutting or excision. A biopsy would have the qualifier of X for diagnostic for a lymph node biopsy.

30. Exercises Practice coding the diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism and the related procedures using the review exercises for Chapter 6.