D60-D64

Aplastic and other anemias and other bone marrow failure syndromes

The ICD-10-CM block D60-D64 encompasses a group of hematologic disorders characterized by the failure of the bone marrow to produce an adequate supply of one or more blood cell lines. This block includes acquired pure red cell aplasia (D60), where only the erythroid precursors are affected; various forms of aplastic anemia (D61), which often involve pancytopenia due to the destruction or depletion of hematopoietic stem cells; and acute posthemorrhagic anemia (D62). It also covers anemias secondary to chronic conditions (D63), such as chronic kidney disease or malignancy, and other specified anemias like sideroblastic anemia and congenital dyserythropoietic anemia (D64). Pathophysiologically, these conditions may result from autoimmune destruction, genetic mutations, viral suppression, or direct toxicity to the bone marrow environment.

Clinical Symptoms

  • Severe fatigue and generalized weakness
  • Shortness of breath (dyspnea), especially on exertion
  • Pallor of the skin, conjunctiva, and nail beds
  • Palpitations or rapid heart rate (tachycardia)
  • Frequent or prolonged infections due to neutropenia
  • Unexplained fever or chills
  • Easy bruising (ecchymosis) and petechiae
  • Mucosal bleeding such as epistaxis (nosebleeds) or gingival bleeding
  • Dizziness or lightheadedness
  • Headache

Common Causes

  • Autoimmune-mediated destruction of hematopoietic stem cells (idiopathic aplastic anemia)
  • Exposure to toxic chemicals such as benzene and certain pesticides
  • Ionizing radiation and high-dose chemotherapy
  • Viral infections including Hepatitis, Epstein-Barr virus (EBV), and Cytomegalovirus (CMV)
  • Direct suppression of erythropoiesis by Parvovirus B19 (especially in pure red cell aplasia)
  • Constitutional genetic syndromes such as Fanconi anemia and Dyskeratosis congenita
  • Chronic inflammatory diseases and malignancies
  • End-stage renal disease (ESRD) leading to erythropoietin deficiency
  • Drug-induced marrow suppression (e.g., chloramphenicol, gold salts, certain NSAIDs)
  • Acute massive blood loss (acute posthemorrhagic anemia)

Documentation & Coding Tips

Distinguish clearly between idiopathic aplastic anemia and pancytopenia due to other causes.

Example: Patient presents with profound fatigue and epistaxis. Laboratory results show hemoglobin 7.1 g/dL, absolute neutrophil count 480/mcL, and platelet count 18,000/mcL. Bone marrow biopsy confirms 15 percent cellularity with no dysplasia or blasts. Diagnosis: Idiopathic aplastic anemia (D61.3). Plan: Evaluate for hematopoietic stem cell transplant. Billing Focus: Specificity of idiopathic etiology. Risk Adjustment: Maps to HCC 46, indicating high complexity marrow failure status.

Billing Focus: Specificity of idiopathic etiology versus secondary causes.

Document the specific drug or external agent in cases of drug-induced bone marrow failure.

Example: Patient with epilepsy on long-term carbamazepine therapy presents with severe neutropenia and anemia. Bone marrow aspiration shows generalized hypoplasia. Diagnosis: Drug-induced aplastic anemia (D61.1) secondary to carbamazepine (T42.1X5A). Billing Focus: External cause code sequencing and link to the specific pharmaceutical agent. Risk Adjustment: Identifies acquired marrow failure which increases medical necessity for specialized monitoring.

Billing Focus: External cause code sequencing and link to the specific pharmaceutical agent.

Specify the type of sideroblastic anemia to capture appropriate clinical severity.

Example: An 82-year-old male with refractory anemia is found to have 25 percent ring sideroblasts on marrow iron stain. Diagnosis: Secondary sideroblastic anemia due to disease (D64.2). Billing Focus: Classification as secondary rather than congenital. Risk Adjustment: Chronic condition status that supports long-term hematological surveillance.

Billing Focus: Classification as secondary rather than congenital.

Identify constitutional or genetic syndromes when marrow failure is linked to inherited conditions.

Example: A 6-year-old child presents with short stature and thumb abnormalities; genetic testing confirms FANCA mutation. Diagnosis: Fanconi anemia (D61.01). Billing Focus: Specific congenital code selection. Risk Adjustment: Significant pediatric complexity factor that impacts long-term care planning.

Billing Focus: Specific congenital code selection.

Record transfusion dependence and iron overload status as co-morbidities.

Example: Patient with chronic aplastic anemia requires red cell transfusions every three weeks to maintain hemoglobin above 7.0. Current ferritin level is 2,200 ng/mL. Diagnosis: Aplastic anemia (D61.3) with transfusion-associated iron overload (E83.111). Billing Focus: Documentation of secondary conditions resulting from treatment. Risk Adjustment: Adds metabolic and hematological complications to the patient profile.

Billing Focus: Documentation of secondary conditions resulting from treatment.

Relevant CPT Codes

Related Diagnoses

Hierarchy