D61.810

Antineoplastic chemotherapy induced pancytopenia

Antineoplastic chemotherapy induced pancytopenia is a serious hematologic condition characterized by a simultaneous deficiency of all three blood cell types—red blood cells (anemia), white blood cells (leukopenia/neutropenia), and platelets (thrombocytopenia)—resulting directly from the toxic effects of chemotherapy. Many cytotoxic antineoplastic agents work by disrupting the cell cycle of rapidly dividing cells. Because hematopoietic stem cells in the bone marrow are naturally highly proliferative, they are often unintentionally targeted, leading to bone marrow suppression (myelosuppression). The severity and duration of the pancytopenia usually depend on the specific drug regimen, dosage, and the patient's baseline marrow reserve. This condition typically peaks at the 'nadir'—the lowest point of blood cell counts—which occurs 7 to 14 days after treatment, posing significant risks for infection, hemorrhage, and severe fatigue.

Clinical Symptoms

  • Severe fatigue and lethargy
  • Shortness of breath (dyspnea) on exertion
  • Pale skin and mucous membranes (pallor)
  • Fever and chills (neutropenic fever)
  • Frequent or unusually severe infections
  • Sore throat or mouth ulcers (stomatitis)
  • Easy bruising (ecchymosis)
  • Petechiae (small red or purple spots on the skin)
  • Epistaxis (nosebleeds)
  • Bleeding gums
  • Tachycardia (rapid heart rate)

Common Causes

  • Alkylating agents (e.g., cyclophosphamide, busulfan)
  • Antimetabolites (e.g., methotrexate, 5-fluorouracil, cytarabine)
  • Antitumor antibiotics (e.g., doxorubicin, daunorubicin)
  • Topoisomerase inhibitors (e.g., etoposide, irinotecan)
  • Platinum-based compounds (e.g., cisplatin, carboplatin)
  • Taxanes (e.g., paclitaxel, docetaxel)
  • High-dose chemotherapy prior to bone marrow transplant
  • Cumulative marrow toxicity from repeated chemotherapy cycles
  • Pre-existing bone marrow dysfunction or low reserve

Documentation & Coding Tips

Establish a clear causal link between the chemotherapy agent and the pancytopenia.

Example: Patient with metastatic lung adenocarcinoma presents 10 days post-Carboplatin/Pemetrexed cycle 2. CBC reveals Hgb 7.2 g/dL, WBC 1.1 K/uL (ANC 450), and Platelets 22 K/uL. Diagnosis: Antineoplastic chemotherapy induced pancytopenia (D61.810) and Adverse effect of antineoplastic drugs (T45.1X5A). Condition is severe and requires immediate G-CSF support and platelet transfusion.

Billing Focus: Requires the addition of an external cause code (T45.1X5A) to identify the specific antineoplastic drug causing the adverse effect.

Explicitly list all three components of pancytopenia to support the acuity and severity of the diagnosis.

Example: Assessment: Chemotherapy induced pancytopenia (D61.810) secondary to FOLFOX regimen for Stage III colon cancer. Patient exhibits Grade 3 anemia, Grade 4 neutropenia, and Grade 2 thrombocytopenia. Clinical management involves postponing cycle 4 and initiating Epoetin alfa and Filgrastim.

Billing Focus: Documentation must specify the encounter is for treatment of the pancytopenia itself, not just the primary malignancy.

Differentiate between pancytopenia and its individual components when they do not all meet clinical criteria for failure.

Example: Post-chemotherapy evaluation: While the patient has leukopenia and thrombocytopenia, hemoglobin remains stable at 12.0. Do not code D61.810; instead, code D70.1 (Antineoplastic chemotherapy induced agranulocytosis) and D69.59 (Other secondary thrombocytopenia).

Billing Focus: Avoids over-coding pancytopenia when all three cell lines are not significantly depressed according to clinical lab thresholds.

Document the need for blood products or growth factors to substantiate the management of the condition.

Example: D61.810: Chemotherapy-induced pancytopenia. Patient is transfusion-dependent for platelets (Z99.89) following cycle 1 of Cytarabine. Received 1 unit of apheresis platelets today for platelet count of 8,000.

Billing Focus: Supports the use of CPT 36430 for blood transfusion and identifies the secondary status of the patient as transfusion dependent.

Note the presence of febrile neutropenia as a comorbid condition to capture the full clinical picture.

Example: Diagnosis: Antineoplastic chemotherapy induced pancytopenia (D61.810). Complication: Febrile neutropenia (D70.1, R50.81). Patient admitted for IV Cefepime and daily Neupogen. ANC nadir 150.

Billing Focus: Multiple codes are required to represent the pancytopenia, the specific neutropenia, and the associated fever.

Specify the phase of care, particularly if this is the initial encounter for this complication or subsequent management.

Example: Initial encounter for chemotherapy-induced pancytopenia (D61.810). Patient presents to oncology clinic with petechiae and fatigue. T45.1X5A appended to signify adverse effect of antineoplastic agents.

Billing Focus: The seventh character A (Initial Encounter) is required for the T45 code to denote the phase of clinical management.

Relevant CPT Codes

Related Diagnoses

Hierarchy