Myelodysplastic syndromes D46- >

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Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. In most cases the manifestation codes will have in the code title, "in diseases classified elsewhere." Codes with this title are a component of the etiology/manifestation convention. The code title indicates that it is a manifestation code. "In diseases classified elsewhere" codes are never permitted to be used as first listed or principle diagnosis codes. They must be used in conjunction with an underlying condition code and they must be listed following the underlying condition.
  • code for adverse effect, if applicable, to identify drug (T36-T50
    ICD-10-CM Range T36-T50

    Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances

    Code First
    • , for adverse effects, the nature of the adverse effect, such as:
    • adverse effect NOS (T88.7)
    • aspirin gastritis (K29.-)
    • blood disorders (D56-D76)
    • contact dermatitis (L23-L25)
    • dermatitis due to substances taken internally (L27.-)
    • nephropathy (N14.0-N14.2)
    Includes
    • adverse effect of correct substance properly administered
    • poisoning by overdose of substance
    • poisoning by wrong substance given or taken in error
    • underdosing by (inadvertently) (deliberately) taking less substance than prescribed or instructed
    Note
    • The drug giving rise to the adverse effect should be identified by use of codes from categories T36-T50 with fifth or sixth character 5.
    Type 1 Excludes
    • toxic reaction to local anesthesia in pregnancy (O29.3-)
    Type 2 Excludes
    • abuse and dependence of psychoactive substances (F10-F19)
    • abuse of non-dependence-producing substances (F55.-)
    • drug reaction and poisoning affecting newborn (P00-P96)
    • pathological drug intoxication (inebriation) (F10-F19)
    Use Additional
    • code(s) to specify:
    • manifestations of poisoning
    • underdosing or failure in dosage during medical and surgical care (Y63.6, Y63.8-Y63.9)
    • underdosing of medication regimen (Z91.12-, Z91.13-)
    • T36 Poisoning by, adverse effect of and unde...
    • T37 Poisoning by, adverse effect of and unde...
    • T38 Poisoning by, adverse effect of and unde...
    • T39 Poisoning by, adverse effect of and unde...
    • T40 Poisoning by, adverse effect of and unde...
    • T41 Poisoning by, adverse effect of and unde...
    • T42 Poisoning by, adverse effect of and unde...
    • T43 Poisoning by, adverse effect of and unde...
    • T44 Poisoning by, adverse effect of and unde...
    • T45 Poisoning by, adverse effect of and unde...
    • T46 Poisoning by, adverse effect of and unde...
    • T47 Poisoning by, adverse effect of and unde...
    • T48 Poisoning by, adverse effect of and unde...
    • T49 Poisoning by, adverse effect of and unde...
    • T50 Poisoning by, adverse effect of and unde...
    with fifth or sixth character 5)
Type 2 Excludes
Type 2 Excludes Help
A type 2 excludes note represents "not included here". A type 2 excludes note indicates that the condition excluded is not part of the condition it is excluded from but a patient may have both conditions at the same time. When a type 2 excludes note appears under a code it is acceptable to use both the code (D46) and the excluded code together.
  • drug-induced aplastic anemia (
    ICD-10-CM Diagnosis Code D61.1

    Drug-induced aplastic anemia

      2016 2017 2018 2019 Billable/Specific Code
    Use Additional
    • code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
    D61.1
    )
Clinical Information
  • A clonal hematopoietic disorder characterized by dysplasia and ineffective hematopoiesis in one or more of the hematopoietic cell lines. The dysplasia may be accompanied by an increase in myeloblasts, but the number is less than 20%, which, according to the who guidelines, is the requisite threshold for the diagnosis of acute myeloid leukemia. It may occur de novo or as a result of exposure to alkylating agents and/or radiotherapy. (who, 2001)
  • A disorder characterized by insufficiently healthy hematapoietic cell production by the bone marrow.
  • A group of diseases in which the bone marrow does not make enough healthy blood cells.
  • Clonal hematopoietic stem cell disorders characterized by dysplasia in one or more hematopoietic cell lineages. They predominantly affect patients over 60, are considered preleukemic conditions, and have high probability of transformation into acute myeloid leukemia.
  • Your bone marrow is the spongy tissue inside some of your bones, such as your hip and thigh bones. It contains immature cells, called stem cells. The stem cells can develop into the red blood cells that carry oxygen through your body, the white blood cells that fight infections, and the platelets that help with blood clotting. If you have a myelodysplastic syndrome, the stem cells do not mature into healthy blood cells. This leaves less room for healthy cells, which can lead to infection, anemia, or easy bleeding.myelodysplastic syndromes often do not cause early symptoms and are sometimes found during a routine blood test. If you have symptoms, they may include
    • shortness of breath
    • weakness or feeling tired
    • skin that is paler than usual
    • easy bruising or bleeding
    • pinpoint spots under the skin caused by bleeding
    • fever or frequent infections
    myelodysplastic syndromes are rare. People at higher risk are over 60, have had chemotherapy or radiation therapy, or have been exposed to certain chemicals. Treatment options include transfusions, drug therapy, chemotherapy, and blood or bone marrow stem cell transplants. nih national cancer institute
Codes
  • D46 Myelodysplastic syndromes
    • D46.0 Refractory anemia without ring sideroblasts, so stated
    • D46.1 Refractory anemia with ring sideroblasts
    • D46.2 Refractory anemia with excess of blasts [RAEB]
      • D46.20 Refractory anemia with excess of blasts, unspecified
      • D46.21 Refractory anemia with excess of blasts 1
      • D46.22 Refractory anemia with excess of blasts 2
    • D46.A Refractory cytopenia with multilineage dysplasia
    • D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
    • D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
    • D46.4 Refractory anemia, unspecified
    • D46.Z Other myelodysplastic syndromes
    • D46.9 Myelodysplastic syndrome, unspecified