Anemia

Definition: Anemia is a condition in which the number of red blood cells or the hemoglobin (Hgb) concentration within them is lower than normal.

Common types of anemia: Iron deficiency, Aplastic, Hemolytic, and Acute blood loss and Chronic blood loss

Hgb is needed to carry oxygen and if you have too few or abnormal red blood cells, or not enough hemoglobin, there will be a decreased capacity of the blood to carry oxygen to the body’s tissues. The most common nutritional cause of anemia is iron deficiency, although deficiencies in folate, vitamins B12 and A are also important causes. 

Common causes include: GI bleed, trauma, surgery, urologic, gynecologic, obstetrical, and retroperitoneal

Diagnostic Criteria

• Hgb for men < 13 gm/dl and women < 12 gm/dl 
• Pregnancy < 11 gm/dl  
• Children over the age of 14 same as adult values 
• Children 6 months-14 years < 11.0 to 12.0 varies based on age

Symptoms will include: fatigue, weakness, dizziness, Diaphoresis, Tachycardia, paleness, Tachypnea, and shortness of breath  

Coding Considerations

Exclude Notes to be aware of with anemia: 

D64.81 Anemia due to antineoplastic chemotherapy-Excludes 2  

• D63.0 Anemia in neoplastic disease 
• D61.1 Aplastic anemia due to antineoplastic chemotherapy
• D62 Acute posthemorrhagic anemia should not be assigned unless the blood loss is specified as ACUTE
• Anemia due to chronic blood loss would be assigned D50.0

R71.0 Precipitous drop in Hgb– Excludes 1 

• Cannot be used when anemia has been diagnosed  
• Nonspecific symptom code
• Primarily intended for OP setting where the cause of the drop in HctT/HgbB is not yet known and requires further evaluation  

Anemia in CKD/ESRD

• D63.1 (Anemia in chronic kidney disease) can never be assigned as principal diagnosis.
  • Per Code First instructional note, “Code first underlying CKD (N18.-)” 

Anemia in Neoplastic Disease

• D63.0 (Anemia in neoplastic disease) can never be assigned as principal diagnosis.
  • Per Code First instructional note, “Code first neoplasm (C00-D49)” 

Review pertinent Coding Clinics such as: 

AHA Coding Clinic, First Quarter 2023, pg. 15: Gastrointestinal bleeding and acute blood loss anemia 

AHA Coding Clinic, First Quarter 2023, pg. 16: Acute blood loss anemia due to angioectasia and gastric ulcer  

AHA Coding Clinic, Third Quarter 2021, pg. 4: Acute myeloid leukemia and anemia due to chemotherapy 

AHA Coding Clinic Third Quarter 2020, pg. 24: Thrombocytopenia and neutropenia  

AHA Coding Clinic, Third Quarter 2019, pg. 11: Acute blood loss anemia due to missed abortion with retained  

AHA Coding Clinic, Third Quarter 2019, pg. 17: Acute on chronic blood loss anemia (both are present only assign D62)  

AHA Coding Clinic, Fourth Quarter 2018, pg. 18: Nutritional anemia and anemia, unspecified

AHA Coding Clinic, First Quarter 2007, pg. 19: Postoperative anemia  

CDI Practice Considerations

• Currently there are no specific criteria established as to what makes blood loss anemia significant.  
• Evaluate measures that suggest a significant drop in Hgb that would warrant a concern would be a transfusion, development of new anemia symptoms, increased complexity of patient needs on current encounter and more frequent monitoring of Hgb and a drop of 1 to 2 gm/dl.  A transfusion is not required for a diagnosis of anemia.  
• Sequencing anemia or GI bleed as a principal diagnosis should be based on the focus of care and treatment. 
• Acute blood loss anemia is not a complication that will impact CMS quality reporting. However, blood loss documented as post operative or postprocedural may lead to a complication code. If the blood loss is inherent or anticipated, CDI should work with educating providers on proper documentation.  

Query Opportunity: 

• Ensure the cause of anemia is clarified when a patient is admitted with anemia, neoplasm and is receiving chemotherapy.  If anemia is linked to the neoplasm, the neoplasm is sequenced first.  However, if the anemia is related to chemotherapy, the anemia is sequenced first.  
• It is important to review the baseline Hgb (if available) and all pertinent information on the current encounter as this will help validate the acuity of the anemia and further determine if a query is warranted.  
• Be aware, pancytopenia includes deficiencies in all three major blood cell lines: anemia, thrombocytopenia, and neutropenia. When all three blood cell groups are simultaneously deficient, review for the presence of pancytopenia and query as appropriate.  
• When present, review and query as necessary for the etiology of pancytopenia. Pancytopenia is classified as a CC, however when documented as due to a drug, or chemotherapy it is recognized as an MCC. 

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