ICD-10 Coding for Pancytopenia(D61.810, D61.811, D61.818)
Complete ICD-10-CM coding and documentation guide for Pancytopenia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Pancytopenia
D61.81-D61.82Primary Range
Other specified aplastic anemias
This range includes codes for pancytopenia due to various causes, including drug-induced and bone marrow infiltration.
Aplastic anemia, unspecified
This code is used when pancytopenia is suspected to be due to aplastic anemia but lacks specific confirmation.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| D61.810 | Antineoplastic chemotherapy-induced pancytopenia | Use when pancytopenia is directly linked to chemotherapy treatment. |
|
| D61.811 | Other drug-induced pancytopenia | Use when pancytopenia is linked to drugs other than chemotherapy. |
|
| D61.818 | Other pancytopenia | Use when pancytopenia is due to non-drug causes. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for pancytopenia
Essential facts and insights about Pancytopenia
Primary ICD-10-CM Codes for pancytopenia
Decision Criteria
clinical Criteria
- Chemotherapy documented as cause with lab values meeting pancytopenia criteria.
Applicable To
- Pancytopenia due to chemotherapy
Excludes
- Pancytopenia due to myelodysplastic syndromes (D46.-)
Clinical Validation Requirements
- ANC <1800
- Hgb <12 g/dL in females, <13 g/dL in males
- Platelets <150,000
- Documentation of chemotherapy treatment
Code-Specific Risks
- Incorrectly coding as D61.818 when chemotherapy is the cause.
Coding Notes
- Ensure documentation specifies chemotherapy as the cause.
D61.811 - Other drug-induced pancytopenia
Use when pancytopenia is linked to drugs other than chemotherapy.
Applicable To
- Pancytopenia due to drugs other than chemotherapy
Excludes
- Pancytopenia due to myelodysplastic syndromes (D46.-)
Clinical Validation Requirements
- ANC <1800
- Hgb <12 g/dL in females, <13 g/dL in males
- Platelets <150,000
- Documentation of drug treatment
Coding Notes
Ensure documentation specifies the drug as the cause.
D61.818 - Other pancytopenia
Use when pancytopenia is due to non-drug causes.
Applicable To
- Pancytopenia due to non-drug causes
Excludes
- Pancytopenia due to myelodysplastic syndromes (D46.-)
Clinical Validation Requirements
- ANC <1800
- Hgb <12 g/dL in females, <13 g/dL in males
- Platelets <150,000
Coding Notes
Ensure documentation specifies non-drug causes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Pancytopenia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code D61.810.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Train staff on documentation requirements., Use templates that prompt for cause documentation.
Impact
Reimbursement: May lead to undercoding and reduced reimbursement., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate data representation of the patient's condition.
Mitigation Strategy
Use the pancytopenia code when all three lineages are affected.
Impact
Reimbursement: Incorrect coding can affect DRG assignment and payment., Compliance: Potential for audit issues and penalties., Data Quality: Misrepresentation of patient data in records.
Mitigation Strategy
Review Excludes1 notes to ensure correct code selection.
Impact
Improper sequencing of pancytopenia and underlying conditions.
Mitigation Strategy
Educate coders on sequencing rules and use decision trees.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Pancytopenia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Pancytopenia
Use these documentation templates to ensure complete and accurate documentation for Pancytopenia. These templates include all required elements for proper coding and billing.
Pancytopenia due to chemotherapy
Specialty: OncologyRequired Elements
- Chemotherapy regimen
- Lab values (Hgb, Platelets, ANC)
- Treatment plan adjustments
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Pancytopenia? Ask your questions below.