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D63.1
ICD-10-CM
Anemia of Chronic Renal Failure

Understand Anemia of Chronic Renal Failure (also called Anemia in Chronic Kidney Disease or Renal Anemia). This resource provides information on diagnosis, clinical documentation, and medical coding for Anemia of Chronic Renal Failure in chronic kidney disease patients. Learn about healthcare best practices for managing and documenting renal anemia for accurate medical coding and improved patient care.

Also known as

Anemia in Chronic Kidney Disease
Renal Anemia

Diagnosis Snapshot

Key Facts
  • Definition : Decreased red blood cell production due to impaired kidney function.
  • Clinical Signs : Fatigue, weakness, shortness of breath, pale skin, dizziness.
  • Common Settings : Chronic kidney disease stages 3-5, dialysis clinics, nephrology.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC D63.1 Coding
N61

Disorders of kidney and ureter

Covers kidney diseases, including those leading to anemia.

D63

Anemia in other diseases classified elsewhere

Includes anemia associated with various conditions, including renal failure.

I12-I13

Hypertensive diseases complicating pregnancy

Can sometimes lead to renal issues and subsequent anemia, though less direct.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the anemia due to chronic kidney disease (CKD)?

  • Yes

    Is CKD stage 1-5 documented?

  • No

    Do NOT code N18.1. Look for other cause of anemia.

Code Comparison

Related Codes Comparison

When to use each related code

Description
Low red blood cells due to kidney failure.
Low iron levels in the blood.
Vitamin B12 deficiency leading to anemia.

Documentation Best Practices

Documentation Checklist
  • Document GFR and staging of chronic kidney disease.
  • Specify anemia type (e.g., normocytic, normochromic).
  • Hgb/Hct levels and dates.
  • Iron studies (ferritin, transferrin saturation, TIBC).
  • EPO level (if measured).

Coding and Audit Risks

Common Risks
  • Unspecified Anemia Type

    Coding anemia without specifying the type (e.g., normocytic, normochromic) may lead to claim denials or inaccurate DRG assignment. Important for CDI and medical coding accuracy.

  • Lack of CKD Stage

    Failing to document the stage of chronic kidney disease impacts risk adjustment and reimbursement. Crucial for healthcare compliance and medical coding audits.

  • Missed Comorbidities

    Overlooking other conditions related to renal anemia, such as iron deficiency or erythropoietin deficiency, can affect coding and quality metrics. Important for CDI specialists.

Mitigation Tips

Best Practices
  • Optimize EPO dosing with Hb monitoring (ICD-10 T85.81XA).
  • Document iron studies for accurate coding (N79.0, Z01.89).
  • Assess for underlying causes, code precisely (ICD-10-CM D63.1).
  • Ensure proper ESA justification for compliance (N18.5).
  • Monitor for adverse effects, document thoroughly.

Clinical Decision Support

Checklist
  • Confirm eGFR <60 mL/min/1.73 m2 (CKD stage 3 or higher)
  • Verify Hb <13.5 g/dL (men) or <12 g/dL (women)
  • Exclude other anemia causes (iron, B12, folate deficiency)
  • Document CKD stage, Hb level, iron studies

Reimbursement and Quality Metrics

Impact Summary
  • Anemia of Chronic Renal Failure reimbursement hinges on accurate ICD-10-CM coding (N18.3) and supporting documentation of CKD stage.
  • Coding quality impacts Anemia of Chronic Renal Failure payor contract negotiations and value-based care reimbursement.
  • Proper coding and documentation affect hospital quality reporting for Anemia of Chronic Renal Failure management and ESRD prevalence.
  • Renal anemia diagnosis specificity (e.g., iron deficiency) improves hospital case mix index for optimal reimbursement.

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Frequently Asked Questions

Common Questions and Answers

Q: What are the best evidence-based treatment strategies for anemia of chronic renal failure in non-dialysis patients?

A: Managing anemia in chronic kidney disease (CKD) not yet requiring dialysis often involves a multi-pronged approach. The cornerstone of treatment typically includes oral iron supplementation to address iron deficiency, a common contributing factor. Explore how intravenous iron therapy can be beneficial if oral iron is ineffective or poorly tolerated, especially when transferrin saturation (TSAT) is low (<20%) and ferritin is <500 ng/mL. Erythropoiesis-stimulating agents (ESAs) like epoetin alfa or darbepoetin alfa are frequently prescribed to stimulate red blood cell production. Consider implementing a patient-specific ESA dosing strategy while closely monitoring hemoglobin levels to avoid overshooting targets and minimize potential adverse events. Furthermore, addressing underlying causes of anemia, such as nutritional deficiencies and inflammation, is crucial for optimal management. Learn more about optimizing ESA and iron therapy based on the latest KDIGO guidelines.

Q: How do I effectively differentiate between anemia of chronic renal failure and other anemia types in a patient with chronic kidney disease?

A: Distinguishing anemia of chronic kidney disease (CKD), also known as renal anemia, from other forms of anemia requires a comprehensive evaluation. A key feature of renal anemia is its association with decreased erythropoietin (EPO) production by the failing kidneys. Clinically, this presents as a normocytic, normochromic anemia. Explore laboratory findings including a low hemoglobin level, reduced reticulocyte count, and normal or slightly decreased mean corpuscular volume (MCV). Consider evaluating serum creatinine, estimated glomerular filtration rate (eGFR), and transferrin saturation (TSAT) to assess kidney function and iron status. While other anemias can coexist with CKD, such as iron deficiency anemia or anemia of chronic inflammation, renal anemia is primarily driven by impaired EPO production. Differentiating these types is vital for targeted treatment. Learn more about the role of bone marrow biopsy in complex cases to assess erythropoietic activity.

Quick Tips

Practical Coding Tips
  • Code N18.3 CKD stage with D63.1
  • Query physician for anemia specifics
  • Document Hgb/Hct for D63.1
  • Consider Z99.2 for renal dialysis

Documentation Templates

Patient presents with symptoms consistent with anemia of chronic renal failure (also known as anemia in chronic kidney disease or renal anemia).  The patient's chronic kidney disease (CKD) stage [Insert CKD stage, e.g., Stage 3, Stage 4, Stage 5] is documented, and laboratory results demonstrate a decreased hemoglobin level of [Insert Hb level, e.g., 9.5 g/dL] and a reduced hematocrit of [Insert Hct, e.g., 28%].  These findings meet the diagnostic criteria for renal anemia secondary to impaired erythropoietin production by the kidneys.  Symptoms reported include fatigue, weakness, shortness of breath on exertion, and pallor.  Differential diagnoses considered include iron deficiency anemia, vitamin B12 deficiency anemia, and anemia of chronic inflammation.  Iron studies, including ferritin and transferrin saturation, have been ordered to evaluate for iron deficiency.  Vitamin B12 levels have also been assessed.  The patient's current medications include [List current medications].  Treatment plan includes monitoring hemoglobin and hematocrit levels, considering erythropoiesis-stimulating agents (ESAs) such as epoetin alfa or darbepoetin alfa, and iron supplementation if indicated.  Patient education provided regarding the importance of medication adherence, dietary considerations, and regular follow-up appointments to optimize management of renal anemia and chronic kidney disease progression.  ICD-10 code D63.1 is applied for anemia in chronic kidney disease.  This documentation supports medical necessity for prescribed treatments and facilitates accurate medical billing and coding.