Icd 10 Cm

Expert opinions on ICD 10 CM code d45 quickly

JPJoan Pfeffer
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June 6, 2024
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18 min read
ICD-10-CM Code D45: Polycythemia Vera

Polycythemia vera is a rare disease of the bone marrow in which there is uncontrolled production of the blood cells (mostly red blood cells), which thickens the blood and can lead to blood clots causing a heart attack or stroke.

ICD-10-CM Code D45: Neoplasms > Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes

Excludes1: Familial polycythemia (D75.0) Secondary polycythemia (D75.1)

Clinical Manifestations:

Polycythemia vera usually develops slowly, and patients may be asymptomatic for years. It’s often discovered on blood tests performed for other conditions. A patient suffering from polycythemia vera can experience: Headache Dizziness Ringing in the ears Chest pain Itchiness Blurred vision Fatigue Excessive sweating Shortness of breath Numbness, tingling Unintentional weight loss Fever A painful big toe Enlarged spleen Bleeding complications such as easy bruising, bleeding from the gums and/or nose, and internal bleeding.

Diagnosis:

Providers diagnose the disease based on history, symptoms, signs, and physical examination. Laboratory studies include CBC, coagulation studies, and blood for oxygen saturation, vitamin B12 levels, uric acid, and erythropoietin. Bone marrow aspiration and/or biopsy will be performed. The provider may order genetic tests on the blood or bone marrow to identify a mutation in the protein Janus kinase 2 (JAK2), which is present in most patients with polycythemia vera.

Treatment:

There is no cure for polycythemia vera. Treatment consists of: Drawing excess blood out of veins (phlebotomy) to keep the hematocrit below 45% Low-dose aspirin Hydroxyurea or other drugs to reduce the number of red blood cells Antihistamines to reduce itching Splenectomy (removal of the spleen) may be performed.

Untreated, this disease can be fatal.

Clinical Responsibility:

Clinicians have the responsibility to diagnose polycythemia vera, monitor patients for complications, and manage their symptoms through treatment and lifestyle changes.

Code Usage Examples:

Example 1: A patient presents with fatigue, dizziness, and itchy skin. Blood tests reveal an elevated hematocrit and a JAK2 mutation, leading to a diagnosis of polycythemia vera. ICD-10-CM Code: D45

Example 2: A patient with a known history of polycythemia vera presents for a follow-up visit. The provider monitors the patient's hematocrit levels, assesses for symptoms, and discusses medication management. ICD-10-CM Code: D45

Example 3: A patient undergoing a routine blood test is found to have a high hematocrit. Further testing reveals a JAK2 mutation, leading to the diagnosis of polycythemia vera. ICD-10-CM Code: D45

Example 4: A patient is hospitalized with complications from polycythemia vera, including shortness of breath, headache, and a risk of stroke. ICD-10-CM Code: D45

Note: It is essential to assign the correct ICD-10-CM code for polycythemia vera based on the patient's specific clinical presentation and documented findings.

Related Codes:

CPT: 0027U JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) gene analysis, targeted sequence analysis exons 12-15 36512 Therapeutic apheresis; for red blood cells 38220 Diagnostic bone marrow; aspiration(s) 38221 Diagnostic bone marrow; biopsy(ies) 38222 Diagnostic bone marrow; biopsy(ies) and aspiration(s) 85007 Blood count; blood smear, microscopic examination with manual differential WBC count 85025 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count 85027 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) 85610 Prothrombin time 85730 Thromboplastin time, partial (PTT); plasma or whole blood 86356 Mononuclear cell antigen, quantitative (eg, flow cytometry), not otherwise specified, each antigen

HCPCS: A9563 Sodium phosphate P-32, therapeutic, per millicurie E0250 Hospital bed, fixed height, with any type side rails, with mattress E0251 Hospital bed, fixed height, with any type side rails, without mattress E0255 Hospital bed, variable height, hi-lo, with any type side rails, with mattress E0256 Hospital bed, variable height, hi-lo, with any type side rails, without mattress E0260 Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress E0261 Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress E0265 Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress E0266 Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress E0270 Hospital bed, institutional type includes: oscillating, circulating and stryker frame, with mattress E0271 Mattress, innerspring E0272 Mattress, foam rubber E0273 Bed board E0274 Over-bed table E0277 Powered pressure-reducing air mattress E0290 Hospital bed, fixed height, without side rails, with mattress E0291 Hospital bed, fixed height, without side rails, without mattress E0292 Hospital bed, variable height, hi-lo, without side rails, with mattress E0293 Hospital bed, variable height, hi-lo, without side rails, without mattress E0294 Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress E0296 Hospital bed, total electric (head, foot and height adjustments). without side rails, with mattress E0297 Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress E0301 Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress E0302 Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress E0304 Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress E0305 Bed side rails, half length E0310 Bed side rails, full length E0315 Bed accessory: board, table, or support device, any type E0316 Safety enclosure frame/canopy for use with hospital bed, any type E0326 Urinal; female, jug-type, any material E0372 Powered air overlay for mattress, standard mattress length and width E0373 Nonpowered advanced pressure reducing mattress E0910 Trapeze bars, also known as Patient Helper, attached to bed, with grab bar E0911 Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed, with grab bar E0912 Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar E0940 Trapeze bar, free standing, complete with grab bar G0089 Professional services, initial visit, for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes G0090 Professional services, initial visit, for the administration of intravenous chemotherapy or other highly complex infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes G0316 Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99223, 99233, and 99236 for hospital inpatient or observation care evaluation and management services). (do not report g0316 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418, 99415, 99416). (do not report g0316 for any time unit less than 15 minutes) G0317 Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99306, 99310 for nursing facility evaluation and management services). (do not report g0317 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418). (do not report g0317 for any time unit less than 15 minutes) G0318 Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99345, 99350 for home or residence evaluation and management services). (do not report g0318 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99417). (do not report g0318 for any time unit less than 15 minutes) G0320 Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system G0321 Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system G0454 Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist G2205 Patients with pregnancy during adjuvant treatment course G2206 Patient received adjuvant treatment course including both chemotherapy and her2-targeted therapy G2208 Patient did not receive adjuvant treatment course including both chemotherapy and her2-targeted therapy G2211 Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition.(add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) G2212 Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99205, 99215, 99483 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes) H0051 Traditional healing service J0216 Injection, alfentanil hydrochloride, 500 micrograms J1434 Injection, fosaprepitant (focinvez), 1 mg J1449 Injection, eflapegrastim-xnst, 0.1 mg J2919 Injection, methylprednisolone sodium succinate, 5 mg J9230 Injection, mechlorethamine hydrochloride, (nitrogen mustard), 10 mg M1018 Patients with an active diagnosis or history of cancer (except basal cell and squamous cell skin carcinoma), patients who are heavy tobacco smokers, lung cancer screening patients Q5122 Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg Q5127 Injection, pegfilgrastim-fpgk (stimufend), biosimilar, 0.5 mg Q5130 Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg

DRG: 820 LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC 821 LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC 822 LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC 823 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC 824 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC 825 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC 840 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC 841 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC 842 LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC

ICD-10-CM Bridge: D45: Polycythemia vera 207.10 Chronic erythremia, without mention of having achieved remission 207.11 Chronic erythremia in remission 207.12 Chronic erythremia, in relapse 238.4 Polycythemia vera

HSS/CHSS: HCC23 Other Significant Endocrine and Metabolic Disorders HCC48 Coagulation Defects and Other Specified Hematological Disorders

MIPS: Oncology/ Hematology Radiation Oncology Urology

Understanding Clinical Scenarios:

It is essential to use appropriate modifiers to describe the circumstances of care for polycythemia vera, especially if the patient requires ongoing treatment or management, or is experiencing complications. For example, if a patient with polycythemia vera is being managed by a physician through phlebotomy and medication, a modifier might be added to the D45 code to clarify the level of management involved. Additionally, if the patient requires admission to the hospital due to complications from the disease, the inpatient codes with relevant modifiers should be assigned.

Understanding the clinical responsibility for polycythemia vera will allow clinicians to properly document care, leading to more accurate coding and better healthcare outcomes.

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