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D64.9
ICD-10-CM
Chronic Anemia

Understanding Chronic Anemia, also known as Anemia of Chronic Disease or Chronic Iron Deficiency Anemia, is crucial for accurate clinical documentation and medical coding. This page provides resources for healthcare professionals concerning the diagnosis, treatment, and management of Chronic Anemia, including ICD-10 codes, SNOMED CT codes, and best practices for clear and concise charting related to this condition. Learn about the connection between Chronic Anemia and iron deficiency, inflammation, and underlying chronic diseases. Explore information on laboratory testing, differential diagnosis, and evidence-based treatment guidelines for Chronic Anemia.

Also known as

Anemia of Chronic Disease
Chronic Iron Deficiency Anemia

Diagnosis Snapshot

Key Facts
  • Definition : Anemia caused by underlying chronic conditions, like inflammation, infection, or kidney disease.
  • Clinical Signs : Fatigue, weakness, shortness of breath, pale skin, headache, dizziness.
  • Common Settings : Primary care, nephrology, rheumatology, oncology.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC D64.9 Coding
D50-D53

Nutritional anemias

Anemias caused by dietary deficiencies, like iron.

D60-D64

Aplastic and other anemias

Covers various anemias, including some chronic types.

D56

Thalassemia

A group of inherited blood disorders causing chronic anemia.

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?

  • Yes

    Code D63.1, Chronic kidney disease with anemia

  • No

    Is the anemia due to neoplasm?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Reduced hemoglobin due to chronic disease.
Iron deficiency leading to low hemoglobin.
Low hemoglobin from impaired red blood cell production.

Documentation Best Practices

Documentation Checklist
  • Chronic Anemia (C) documentation checklist:
  • ICD-10-CM code D63.8 (Other specified anemias): Verify underlying cause.
  • Document Hgb, Hct, RBC indices, iron studies, & related labs.
  • Specify anemia type (e.g., normocytic, microcytic).
  • Assess for underlying chronic diseases (e.g., CKD, inflammation).
  • Document treatment plan & patient education.

Coding and Audit Risks

Common Risks
  • Specificity Coding

    Coding anemia type (iron deficiency vs. chronic disease) requires specific documentation to avoid unspecified anemia coding (D64.9).

  • Underlying Cause

    Chronic anemia often has a root cause (e.g., CKD, malignancy). Coding should capture both anemia and etiology for accurate reimbursement.

  • Severity Documentation

    Anemia severity (mild, moderate, severe) impacts clinical decision-making and must be clearly documented to support coding and quality metrics.

Mitigation Tips

Best Practices
  • Document underlying disease impacting Hb/Hct (ICD-10-CM coding)
  • Check iron studies, reticulocyte count for accurate subtype diagnosis (CDI)
  • Consider EPO stimulating agents if CKD-related (NCCN guidelines, compliance)
  • Optimize underlying disease management to improve anemia (best practice)
  • Ensure iron supplementation if iron deficiency coexists (evidence-based medicine)

Clinical Decision Support

Checklist
  • Verify Hb/Hct consistently low: ICD-10 D63.8, document duration.
  • Assess for underlying chronic conditions: inflammation, infection, malignancy.
  • Iron studies: Ferritin, transferrin saturation. Document results.
  • Exclude other anemia causes: B12/folate, hemolysis. Review peripheral smear.

Reimbursement and Quality Metrics

Impact Summary
  • Chronic Anemia reimbursement hinges on accurate ICD-10-CM coding (e.g., D50-D64) impacting DRG assignment and payment.
  • Coding quality affects CMI for Chronic Anemia cases, influencing hospital reimbursement and quality reporting.
  • Proper documentation of Chronic Anemia subtypes (Iron Deficiency, etc.) is crucial for appropriate reimbursement.
  • Anemia severity documentation impacts coding, directly affecting MS-DRG assignment and hospital payments.

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Frequently Asked Questions

Common Questions and Answers

Q: What are the key differentiating lab findings between Iron Deficiency Anemia (IDA) and Anemia of Chronic Disease (ACD) in adult patients?

A: Differentiating Iron Deficiency Anemia (IDA) and Anemia of Chronic Disease (ACD) can be challenging due to overlapping symptoms. However, key lab findings can help distinguish them. In IDA, serum iron is low, ferritin is low, total iron-binding capacity (TIBC) is high, and transferrin saturation is low. Conversely, in ACD, serum iron is low, ferritin can be normal or even high (due to inflammation), TIBC is normal or low, and transferrin saturation is low. Additionally, inflammatory markers like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are often elevated in ACD but normal in IDA. Explore how reticulocyte counts and the mean corpuscular volume (MCV) can provide further diagnostic clues. Consider implementing these lab value comparisons in your anemia diagnostic workflow for improved patient management.

Q: How do I effectively manage chronic anemia in patients with chronic kidney disease (CKD), considering both iron supplementation and erythropoiesis-stimulating agents (ESAs)?

A: Managing chronic anemia in patients with chronic kidney disease (CKD) requires a multifaceted approach. Iron supplementation is often necessary as CKD patients frequently have functional iron deficiency. However, it’s crucial to assess iron status through serum ferritin, transferrin saturation, and other relevant markers before initiating iron therapy. Oral iron may be insufficient due to absorption issues, and intravenous iron might be needed. Erythropoiesis-stimulating agents (ESAs) can stimulate red blood cell production, but their use should be guided by hemoglobin targets and potential side effects like thrombosis. Learn more about the latest guidelines for ESA usage in CKD patients to ensure optimal and safe treatment strategies. Consider implementing a patient-specific approach considering comorbidities and individual responses to therapy.

Quick Tips

Practical Coding Tips
  • Code C for Anemia documentation
  • Specify type if chronic
  • Query MD for clarity if unclear
  • Check iron studies for deficiency
  • Document underlying disease always

Documentation Templates

Patient presents with signs and symptoms consistent with chronic anemia, also known as anemia of chronic disease or chronic iron deficiency anemia.  The patient reports fatigue, weakness, and shortness of breath, particularly on exertion.  Physical examination reveals pallor and tachycardia.  The underlying cause of the chronic anemia is suspected to be [Specify underlying condition, e.g., chronic kidney disease, inflammatory bowel disease, rheumatoid arthritis, etc.].  Laboratory findings demonstrate a low hemoglobin level of [Insert value] g/dL, hematocrit of [Insert value]%, and mean corpuscular volume (MCV) of [Insert value] fL, indicating [Specify microcytic, normocytic, or macrocytic anemia].  Iron studies, including serum iron, ferritin, and total iron-binding capacity (TIBC), were ordered to further evaluate iron status and differentiate from iron deficiency anemia.  The patient's medical history includes [List relevant medical history].  Current medications include [List current medications].  Differential diagnosis includes other causes of anemia such as vitamin B12 deficiency, folate deficiency, and thalassemia.  The patient's chronic anemia diagnosis is confirmed based on the clinical presentation, laboratory results, and underlying medical condition.  Treatment plan includes addressing the underlying disease process and potential iron supplementation if indicated.  Patient education was provided regarding dietary modifications, symptom management, and the importance of follow-up appointments to monitor hemoglobin levels and response to treatment.  ICD-10 code [Insert appropriate ICD-10 code, e.g., D63.8, D50.8] is being considered for this encounter.