Basic ICD 10-CM/PCS and ICD-9-CM Coding, 2015 Edition

1. Basic ICD 10-CM/PCS and ICD-9-CM Coding, 2015 Edition Chapter 7: Diseases of the Blood and Blood-Forming Organs

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

3. ICD-9-CM and Deficiency Anemias • Deficiency anemias • ICD-9-CM Category 280, Iron deficiency • Most common type of deficiency anemia • May be due to acute or chronic blood loss • ICD-9-CM Category 281, Other deficiency anemias • May be referred to megaloblastic anemias • Deficiency of vitamin B12, or folic acid • May be caused by antineoplastic or immunosuppressive drugs

4. ICD-9-CM and Hemolytic Anemias • Hemolytic anemias • Abnormal reduction of red blood cells caused by increased rate of red blood cell destruction or the inability of the blood marrow to compensate • ICD-9-CM Category 282, Hereditary • Thalassemias • Sickle-cell disease or trait • ICD-9-CM Category 283, Acquired through extrinsic factors • Trauma, infection, systemic diseases • Exposure to toxins/drugs • Unknown cause

5. ICD-9-CM Aplastic Anemia • ICD-9-CM Category 284, Aplastic anemia • Group of bone marrow disorders which involve anemia as well as pancytopenia • Caused by abnormal reduction of red blood cells due to lack of bone marrow production • Caused by exposure to toxins such as chemotherapy or radiation and other drugs • Cause may be unknown

6. ICD-9-CM and Other Anemias • ICD-9-CM Category 285, Other and unspecified anemia • 285.0, Sideroblastic anemia • 285.1, Acute posthemorrhagic anemia • 285.21, Anemia of end stage renal disease • 285.22, Anemia in neoplastic disease • 285.29, Anemia of other chronic illness

7. Other Anemias (continued) • ICD-9-CM Code 285.3, Antineoplastic chemotherapy-induced anemia • Acquired from the administration of chemotherapy used to treat a malignancy; one of the most common side effects of cancer treatment (20–60 percent of patients) • Cancer drugs inhibit the production of bone marrow and reduce the number of red blood cells produced • Anemia usually short term and not aplastic

8. ICD-9-CM and Coagulation Defects • Disorders of platelets that result in a serious bleeding due to a deficiency of one or more clotting factors • ICD-9-CM Category 286, Coagulation defects • Congenital • Acquired

9. Coagulation Defects (continued) • Three types of congenital coagulation defects with ICD-9-CM codes: • Classic hemophilia A: factor VIII deficiency (286.0) • Hemophilia B: factor IX deficiency (286.1) • Hemophilia C: factor XI deficiency (286.2) • Defects can also be acquired

10. Coagulation Defects (continued) • Hemorrhagic disorder due to intrinsic circulating anticoagulant; this is a rare condition • ICD-9-CM code 286.5 • Frequently confused with more common problem of hemorrhage due to anticoagulant drug therapy with lab results showing prolonged prothrombin time

11. Coagulation Defects (continued) • ICD-9-CM Code 286.5 is not assigned for: • Patient on anticoagulant therapy • Patient who develops bleeding or hemorrhage as result of anticoagulants • Instead code the medical condition (such as atrial fibrillation or old CVA) and associated hemorrhage (such as hematuria) the patient exhibits with an additional code for the therapeutic use of anticoagulants (E934.2)

12. Coagulation Defects (continued) • ICD-9-CM Code 286.5 is not assigned for: • Patient who has a prolonged prothrombin time or other abnormal coagulation profiles as a laboratory finding • Code 790.92 assigned for abnormal laboratory finding • However, if patient is receiving anticoagulant therapy, a prolonged bleeding time is expected and code 790.92 is not assigned

13. ICD-9-CM and Purpura • ICD-9-CM Category 287, Purpura and other hemorrhagic conditions • Thrombocytopenia is diagnosed when platelets fall below 100,000/mm

14. Purpura (continued) • Two forms of thrombocytopenia • Primary or idiopathic thrombocytopenia • Idiopathic thrombocytopenic purpura (ITP), which is an autoimmune disorder with development of antibodies to one’s own platelets • May be congenital or acquired • Coded according to the type of purpura

15. Purpura (continued) • Secondary thrombocytopenia • Complication of another disease • Causes may be infections, lupus, leukemia, sarcoidosis, or carcinoma of ovary • Complication of bone marrow transplant • May be caused by chemotherapy • Treatment focuses on correcting underlying disease or changing medications

16. ICD-9-CM and Diseases of White Blood Cells • ICD-9-CM Category 288, Diseases of white blood cells • Fourth and fifth digits identify specific type of disorder • Two types of white cells: • Granular leukocytes: neutrophils, eosinophils, and basophils • Nongranular or agranular leukocytes: lymphocytes and monocytes

17. Diseases of White Blood Cells (continued) • Agranulocytosis or Neutropenia, ICD-9-CM code 288.0 • Fifth digit indicates specific types • Acute condition with absence of neutrophils and extremely low granulocyte count • Caused by drug toxicity or hypersensitivity • Commonly occurs in patients receiving chemotherapy

18. Other Blood and Blood-forming Organ Diseases • ICD-9-CM Category 289, Other diseases of blood and blood-forming organs, includes • Conditions not coded elsewhere • Familial and secondary polycythemia • Chronic lymphadenitis • Hypersplenism • Myelofibrosis • Heparin-induced thrombocytopenia

19. 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 Similar to ICD-9-CM, 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

20. 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

21. ICD-10-CM Coding Guidelines and Instructional Notes, Chapter 3 Instructional notes with certain anemia codes instructs the coder to use an additional E code to identify the cause if drug-induced Similar instruction exists with agranulocystosis conditions that are drug induced

22. ICD-10-CM Coding Guidelines and Instructional Notes, Chapter 3 Code first note exists with certain anemia codes to code first (T36–T50) to identify drug that caused anemia Use with codes for drug induced anemia Drug-induced folate deficiency anemia Drug-induced autoimmune hemolytic anemia Drug-induced aplastic anemia Aplastic anemia due to other external agents

23. ICD-10-CM Coding Guidelines and Instructional Notes, Chapter 3 Two instructions appear with a code for the type of anemia produced by either a poisoning or an adverse effect of a drug D70.1 Agranulocytosis secondary to cancer chemotherapy Use additional code for adverse effect if applicable to identify drug (T45.1x5) Code also underlying neoplasm

24. ICD-10-CM Coding Guidelines and Instructional Notes, Chapter 3 Two instructions appear with a code for the type of anemia produced by either a poisoning or an adverse effect of a drug D89.1 Graft-versus-host disease Code first underlying cause Use additional codes to identify associated manifestation

25. ICD-10-CM Coding Guidelines and Instructional Notes, Chapter 3 Three instructions appear with a code for myelofibrosis D75.81 Myelofibrosis Code first underlying disorder Use additional code, if applicable, for associated therapy-related myelodysplastic syndrome Use additional code for adverse effect, if applicable, to identify drug (T45.1X5)

26. ICD-10-CM Coding Guidelines and Instructional Notes, Chapter 3 Coding guideline for anemia associated with malignancy: When admission or encounter is for management of anemia associated with the malignancy, and the treatment is only for anemia, the appropriate code for the malignancy is sequenced first followed by code D63.0, Anemia in neoplastic disease

27. ICD-10-CM Coding Guidelines and Instructional Notes, Chapter 3 There are directions for coding anemia with chemotherapy, immunotherapy and radiation therapy Example: 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

28. ICD-10-CM Coding Guidelines and Instructional Notes, Chapter 3 Example is coded as Type of anemia treated and sequenced first The neoplasm being treated The adverse effect (T45.1X5) of antineoplastic and immunosuppressive drugs

29. ICD-10-CM Coding Guidelines and Instructional Notes, Chapter 3 Example of a patient with management of anemia associated with adverse effect of radiation is coded Type of anemia treated and sequenced first The neoplasm being treated with radiation Y84.1, Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or later complications, without mention of misadventure

30. ICD-10-CM Coding Overview, Chapter 3 • Chapter 3 of ICD-10-CM contains codes from ICD-9-CM chapter 4, Diseases of blood and blood-forming organs with other codes from ICD-9-CM chapter 3, Endocrine, nutritional and metabolic diseases and immunity disorders • Intraoperative and postprocedural complications of the spleen was added to chapter 3 of ICD-10-CM