The question is simple – What is anemia? However, the answer is not necessarily so simple. Anemia is a condition that is marked by a deficiency of red blood cells, or hemoglobin. Anemia can be linked to a variety of conditions and diseases, and can affect people of all ages, races, and ethnicities. The more common forms of anemia are noted below.
NUTRITIONAL-DEFICIENCY ANEMIAS
According to Merriam-Webster.com, a nutritional deficiency is “an inadequate supply of essential nutrients (as vitamins and minerals) in the diet resulting in malnutrition or disease.” Anemia is one of the diseases that can result. Iron-deficiency anemia is the most common type; low levels of folate or vitamin B-12 can also cause nutritional-deficiency anemias.
Iron-deficiency anemia causes RBCs to appear oval-shaped, pale, and small when viewed through a microscope. Symptoms can include (but are not limited to): pale skin; tinnitus; changes in the sense of taste; a sore tongue; depression; changes in the menstrual cycle; spoon-shaped finger- and toenails. Causes include poor dietary iron intake, low vitamin C intake, and having a condition, like celiac disease, that inhibits the body from adequately absorbing nutrients. Treatments include change in diet and/or taking iron supplements.
Vitamin-deficiency anemias occur when one’s diet is deficient in cobalamin (vitamin B-12) or folate (B-9). Vitamin-deficiency anemia, which is also known as megaloblastic anemia, can also develop if the body cannot properly absorb nutrients. It is very common in older people. Megaloblastic anemia causes RBCs to become too large; it can also cause the body to produce too few RBCs. Symptoms include: tingling or a feeling of pins and needles; mouth ulcers; muscle weakness; confusion/problems with concentration, thinking, and memory, among other things. Treatment includes change in diet and/or taking specific vitamin supplements.
APLASTIC ANEMIA
Aplastic anemia is a rare form of anemia and occurs when the bone marrow does not produce sufficient numbers of RBCs, WBCs, and/or platelets. The exact cause of aplastic anemia is unknown, but is thought to be related to an autoimmune disorder, a viral infection, and/or exposure to toxic chemicals (including chemotherapy for cancer). It can also be an inherited condition. Treatment depends on the cause of the anemia, and can include blood transfusions, blood and marrow stem cell transplants, and lifestyle changes.
SICKLE CELL ANEMIA
Most commonly found in those of African descent, this type of anemia is characterized by problems with hemoglobin that cause RBCs to have a crescent (or sickle) shape. The body automatically destroys these cells but the body cannot generate new RBCs quickly enough. Sickle cell anemia is a genetic disorder. This type of anemia can be painful. Treatment depends on severity and includes medications, transfusions, and, rarely, bone marrow transplants
HEMOLYTIC ANEMIA
When RBCs are destroyed faster than the bone marrow can manufacture new ones, the result is hemolytic anemia. The “premature death” of the RBCs could be caused by an inherited condition; however, it can also be caused by outside factors such as autoimmune disorders and even some medications. Like other anemias, treatment will depend on the cause of the anemia and typically includes blood transfusions, medications, surgery and procedures, and lifestyle changes.
ANEMIA OF CHRONIC DISEASE
Having a chronic disease, such as Crohn’s disease, HIV/AIDS, rheumatoid arthritis, and kidney disease can cause anemia. Treatment would depend on how the anemia manifests itself, and also treating the chronic disease that caused it.
ANEMIAS ASSOCIATED WITH BONE MARROW DISEASE
Cancer (such as leukemia) and cancer-like disorders (myelodysplasia, multiple myeloma, etc.) can disrupt or even totally shut down the bone marrow’s blood-cell-making process. Treatment would be unique to the disease/disorder that was responsible for the anemia.
ICD-10-CM CODING EXAMPLES FOR ANEMIA
| CATEGORY CODE |
DESCRIPTION |
| D50.8 | Other Iron Deficiency Anemias
Iron deficiency anemia due to inadequate iron intake |
| D50.9 | Iron Deficiency Anemia Unspecified |
| D51.1 | Vitamin B12 Deficiency Anemia due to Selective Vitamin B12 Malabsorption with Proteinuria
Megaloblastic hereditary anemia |
| D51.2 | Transcobalamin II Deficiency |
| D51.3 | Other Dietary Vitamin B12 Deficiency Anemia
Vegan anemia |
| D51.8 | Other Vitamin B12 Deficiency Anemias |
| D51.9 | Vitamin B12 Deficiency Anemia, Unspecified |
| D52.0 | Dietary Folate Anemia
Nutritional megaloblastic anemia |
| D52.1 | Drug-Induced Folate Deficiency Anemia
Use additional code for adverse effect, if applicable, to identify drug (T36-T50) with fifth or sixth character of 5 |
| D52.8 | Other Folate Deficiency Anemias |
| D52.9 | Folate Deficiency Anemia, Unspecified
Folic acid deficiency anemia NOS |
| D53.1 | Other Megaloblastic Anemias, Not Elsewhere Classified
Megaloblastic anemia, NOS |
| D53.9 | Nutritional Anemia Unspecified
Simple chronic anemia Excludes anemia NOS (D64.9) |
| D57.- | Sickle Cell Disorders
Use additional code for any associated fever (R50.81) Excludes other hemoglobinopathies (D58.-) |
| D58.8 | Other Specified Hemolytic Anemias |
| D58.9 | Hereditary Hemolytic Anemia, Unspecified |
| D59.8 | Other Acquired Hemolytic Anemias |
| D59.9 | Acquired Hemolytic Anemia, Unspecified
Idiopathic hemolytic anemia, chronic |
| D61.- | Other Aplastic Anemias and Other Bone Marrow Failure Syndromes
Excludes neutropenia (D70.-) |
The ICD-10-CM codes noted on above chart pertain to the anemias discussed in the blog and are examples only. The list of codes is in no way complete. As always, coders should review chart documentation and refer to the ICD-10-CM book (or encoder) to make certain the correct code is assigned, based on documentation found in the patient record.
References:
https://www.nhlbi.nih.gov/files/docs/public/blood/anemia-inbrief_yg.pdf
https://www.medicalnewstoday.com/articles/188770
https://www.medbroadcast.com/channel/nutrition/diet-and-disease/types-of-anemia
