Understanding ICD-9-CM Coding Mary Jo Bowie MS, RHIA, RHIT Regina Schaffer AAS, RHIA, CPC

Diseases of the Blood and Blood-Forming Organs CHAPTER Diseases of the Blood and Blood-Forming Organs 9

Blood Composed of plasma Cellular elements Liquid portion Erythrocytes or Red Blood Cells (RBC) Leukocytes or White Blood Cells (WBC) Thrombocytes or platelets

Anemia Decrease in red blood cells Important to know the type of anemia Review medical record Query provider

Iron Deficiency Anemia Category Code 280 Insufficient supply of iron Blood loss Inadequate dietary iron intake Fourth-digit assignment for specific type of iron deficiency anemia

Other Deficiency Anemias Fourth digit indicates type of deficiency 0 Pernicious anemia 1 Other vitamin B12 deficiency anemia 2 Folate-deficiency anemia 3 Megoblastic anemia, NEC

Other Deficiency Anemias 4 Protein-deficiency 8 Other specified nutritional deficiency 9 Unspecified deficiency anemia

Hemolytic Anemias Red blood cells are broken down faster than they are produced Acquired forms—category 283 Hereditary forms—category 282

Sickle-Cell Anemia/Trait Inherited sickle-cell trait Asymptomatic condition Genetic trait from one parent Sickle-cell anemia Genetic trait from both parents Abnormal type of hemoglobin in RBC Additional code for crisis

Aplastic Anemia Failure of bone marrow to produce blood components Congenital—code 284.01

Aplastic Anemia Acquired—code 284.8x Chronic systemic disease Infection Exposure to drugs Radiation or other chemicals

Other Anemias Due to blood loss from trauma or injury Chronic illness External or internal Chronic or acute Chronic illness Admission for anemia—primary diagnosis Admission for chronic illness—primary diagnosis

Coagulation Defects Deficiency in one or more clotting factors Prolonged clotting time Serious bleeding Fourth digit identifies congenital: Christmas Disease, Von Willebrand’s Disease

Coagulation Defects Or acquired hemorrhagic disorders due to circulation anticoagulants

Anticoagulants Anticoagulant therapy Medication therapy to prevent blood clots Coumadin therapy Prothrombin Time (PT) Code condition and E934.2

Abnormal Prothrombin Time If lab result is NOT due to anticoagulation therapy, code 790.92 is assigned Coder must read supporting documentation to assign proper code

Purpura and Other Hemorrhagic Conditions Accumulation of blood under skin that forms pinpoint hemorrhages Thrombocytopenia Abnormal decrease in platelet count causing purpural hemorrhages

White Blood Cells 288 category code Neutropenia—288.00 Leukemia is not in this category