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ICD-10-CM Coding Guidelines - Disease of the Blood and Blood-Forming Organs and Certain Disorders involving the Immune Mechanism (Chapter 3) and Endocrine, Nutritional, and Metabolic Diseases (Chapter 4)
 
 

ICD-10-CM Coding Guidelines - Disease of the Blood and Blood-Forming Organs and Certain Disorders involving the Immune Mechanism (Chapter 3) and Endocrine, Nutritional, and Metabolic Diseases (Chapter 4)

 

Disease of the Blood and Blood-Forming Organs and Certain Disorders involving the Immune Mechanism (Chapter 3)

Blood disorders include coagulation defects, anemias, and various other disorders of the blood components. Chapter 3 of ICD-10-CM is titled "Disorders of the Blood and Blood-Forming Organs and Certain Disorders involving the Immune Mechanism," which includes code categories D50-D89:

  • D50-D53 Nutritional Anemias – Nutritional anemias are considered "deficiency disorders." The codes in this subsection correspond with those in categories 280-281 in ICD-9-CM. Conditions coded include iron deficiency anemia, Vitamin B12 deficiency anemias, and other anemias related to vitamin, protein, mineral, and other nutritional deficits.

  • D55-D59 Hemolytic Anemia – The codes in this subsection correspond with those in categories 282-283 in ICD-9-CM. Conditions coded include sickle cell anemia, thalassemia, and other diseases caused by enzyme disorders.

  • D60-D64 Aplastic and Other Anemias and Other Bone Marrow Failure Syndromes – Aplastic anemia is the inability to produce new blood cells. These disorders occur due to bone marrow problems. The codes in this subsection correspond with those in categories 284-285 in ICD-9-CM. Conditions coded usually require the assignment of multiple codes to accurately describe the condition.

  • D65-D69 Coagulation Defects, Purpura, and Other Hemorrhagic Conditions – The codes in this subsection apply to various disorders of blood clotting, and they correspond with those in categories 286-287 in ICD-9-CM. Conditions of coagulopathy refer to a disorder of blood clotting due to adverse effects of medications, due to an intrinsic impairment or deficiency of plasma proteins, or from an external cause.

  • D70-D77 Other Disorders of Blood and Blood-Forming Organs – Codes in this subsection correspond with those in categories 288-289 in ICD-9-CM. Conditions coded include functional disorders of neutrophils, white blood cell disorders, diseases of the spleen, and other blood-related conditions.

  • D78 Intraoperative and Postprocedural Complications of Spleen – Codes in this subsection are not found in ICD-9-CM. Conditions coded include intraoperative or postoperative hemorrhage, hematoma of the spleen, accidental puncture/laceration of the spleen during surgery, and other complications related to surgery of the spleen.

  • D80-D89 Certain Disorders Involving the Immune Mechanism – Codes in this subsection correspond with those in category 279 in ICD-9-CM. Conditions coded include immunodeficiency with antibody defects, sarcoidosis, immune reconstitution syndrome, and other immune mechanism problems (Grebner & Suarez, 2013).

General Guidelines

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  • An assignment of code D62, Acute posthemorrhagic anemia, should be adequately documented. If the documentation does not specify acuity, the default code used is D50.0, iron deficiency anemia secondary to blood loss (chronic).

  • When folate deficiency anemia is secondary to medication therapy, the coder should use D52.1, Drug-induced folate deficiency anemia.

  • For aplastic anemia that is drug-induced or due to other external causes, a code should be used first to identify the substance, followed by the anemia code.

  • Codes in category D63, Anemia in chronic diseases classified elsewhere, should be assigned as secondary codes, preceded by the code for the underlying disease (Grebner & Suarez, 2013).

Endocrine, Nutritional, and Metabolic Diseases (Chapter 4)

Diseases of the endocrine system are classified along with metabolic and nutritional conditions. These conditions include thyroid disorders, diabetes mellitus, malnutrition, overweight, obesity, metabolic disorders, pancreatic internal secretions, and postprocedural complications. The ICD-10-CM Chapter 4 is titled "Endocrine, Nutritional, and Metabolic Diseases," which refers to code categories E00-E89:

  • E00-E07 Disorders of Thyroid Gland - Codes in this subsection correspond with those in categories 240-246 in ICD-9-CM. When assigning codes for thyroid disorders, the coder known the cause of the condition, whether it is acquired or congenital, and if or not it resulted from medical treatment. Also, it is important to note the presence of a goiter, a thyrotoxic storm, or a crisis.

  • E08-E13 Diabetes Mellitus - Codes in this subsection correspond with those in categories 249-250 in ICD-9-CM. With ICD-10-CM, combination codes are often used for this category. When diabetes is related to an underlying condition, the coder should use the sequencing instructions provided in the Tabular List.

  • E15-E16 Other Disorders of Glucose Regulation and Pancreatic Internal Secretion - Codes in this subsection correspond with those in category 251 in ICD-9-CM. Conditions coded include non-diabetic drug-induced insulin coma, increased secretion of glucagon, and hypoglycemic coma, just to name a few.

  • E20-E35 Disorders of Other Endocrine Glands - Codes in this subsection correspond with those in categories 252-259 in ICD-9-CM. Conditions coded include hypoparathyroidism, hyperparathyroidism, Cushing's syndrome, thymus disorders, and puberty disorders.

  •  E40-E46 Malnutrition - Codes in this subsection correspond with those in categories 262-263 in ICD-9-CM. Conditions coded include malnutrition marasmus, protein-calorie malnutrition, kwashiorkor, and retarded development due to malnutrition. 

  • E50-E64 Other Nutritional Deficiencies - Codes in this subsection correspond with those in categories 264-269 in ICD-9-CM. Conditions coded include deficiencies of vitamins, minerals, fatty acids, and other nutrients. 

  • E65-E68 Overweight, Obesity, and Other Hyperalimentation - Codes in this subsection correspond with those in category 278 in ICD-9-CM. Obesity codes are listed by the extent and type of obesity. When the obesity is a complicating factor in pregnancy, a code from the subclassification O99.21- is assigned first, followed by a code from the E66 category.

  • E70-E90 Metabolic Disorders – Codes in this subsection correspond with those in categories 270-277 in ICD-9-CM. Conditions coded include metabolism disorders of amino acids, lysine, ketones, fructose, and cholesterol, just to name a few (Grebner & Suarez, 2013).

General Guidelines

  • When it is documented that the patient uses insulin, but the type of diabetes is not recorded, the coder should use code E11, Type 2 diabetes mellitus, followed by Z79.4, Long-term use of insulin.

  • If the diabetes is secondary to an underlying condition, the coder should use E09, Drug or chemical induced diabetes mellitus.

  • When reporting drug-induced adrenocortical insufficiency or hypopituitarism, the coder should use a code from T36-T50 first, followed by E23.1.

  • When reporting sequelae and late effects of nutritional deficiencies, the coder should first use the code that identifies the condition that results from the malnutrition, followed by a code from the E64 category.

  • When reporting sequelae of hyperalimentation, the coder should first use the code that identifies the condition that results from the hyperalimentation, followed by a code from the E68 category (Davis, 2011; Grebner & Suarez, 2013).

 

 
 
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