Anemia is a common, treatable condition that is both underdiagnosed and undertreated.
Anemia carries a huge impact on the health and quality of life of patients. The average per-patient costs for anemic patients are 54% higher than for non-anemic patients. The type of anemia or etiology of anemia and any of its complications can increase the resources utilized or costs incurred by the hospital or facility by lengthening the patient’s stay, costs of transfusions and the treatment or medications given.
Ensuring complete and accurate code assignment is one way to recover the costs incurred from treating the patient’s anemia. Failure to clarify the type of anemia may mean the incorrect DRG is assigned and does not reflect the patient’s severity of illness and resources required for treatment of the patient.
Recognizing query opportunities requires understanding the types of anemia, its complications and treatment.
In anemia a lower-than-normal number of healthy red blood cells is produced leading to an amount that is insufficient to meet the body’s physiological needs.
Red blood cells carry oxygen throughout the body. When oxygen levels are too low to meet the body’s demands, many different symptoms may develop. These include:
In general anemia can be divided into two groups, acquired anemias and inherited anemias. Some anemias may be inherited or acquired.
Diagnostic tests are performed on the blood or blood forming structures to determine a diagnosis of anemia.
| Patient Type | Normal Hemoglobin Level gm/dl |
| Men | 14-17.4 grams |
| Women | 12-16 |
| Children >14 years of age | Same as adults |
| Children 6 months-<14 years of age | 9.5-24.5 depending on age of child |
Anemia is commonly treated with medication, nutritional supplements. Surgical treatments include blood transfusion, transplant of blood forming cells and surgery to control bleeding.
Recognizing clinical indicators of anemia is essential to identifying opportunities to query for this condition. Clinical indicators of anemia include:
Note: Transfusion is NOT a requirement for diagnosis- clinically monitoring of hemoglobin (Hbg) is sufficient
The need for accurate documentation and review of clinical information makes coding anemia challenging. Coders must be able to differentiate between acute and chronic anemia, identify the specific cause (e.g., blood loss (including acuity), chronic disease, hemolytic, due to medications or inherited (genetic) etc.), and understand the impact of underlying conditions.
Clear and detailed documentation from providers is essential for accurate code assignment. Coders may need to query providers for clarification on ambiguous or unclear documentation.
These ICD-10-CM Official Guidelines for Coding and Reporting from chapter 2 provide guidance in sequencing codes for anemia associated with malignancies.
A query for the presence of and type anemia is appropriate when the documentation supports the patient experiencing signs and symptoms of anemia, meets clinical criteria suggesting anemia and the patient is administered treatment. A clinical validation query is appropriate when there is documentation of a specific type of anemia that is not clinically supported.
References
For more than 30 years, HIA has been the leading provider of compliance audits, coding support services and clinical documentation audit services for hospitals, ambulatory surgery centers, physician groups and other healthcare entities. HIA offers PRN support as well as total outsource support.
The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.