Pancytopenia

Pancytopenia: A hematologic condition where there is a lower-than-normal number of red and white blood cells and platelets in the blood. Common etiologies include, but are not limited to: 

• Autoimmune disorders
• Bone marrow disorders
• Genetic disorders
• Infection (e.g., COVID-19, Sepsis, HIV infections)
• Poor nutrition
• Pregnancy
• Chemotherapy
• Radiation therapy
• Exposure to certain toxins, chemicals or medicines
• Myeloid neoplasms
• Aplastic anemia
• Megaloblastic anemia

Diagnostic Criteria

Thresholds depends on age, sex, race and varying clinical scenarios, however generally recognized criteria is: 

• Hemoglobin: <12g/dL in women; <13 g/dL men 
• Platelets: <150,000 
• WBC: < 4,000 per ml; OR an absolute neutrophil count < 1800 per ml  

Signs and symptoms may include abnormal bleeding, fatigue, dizziness, weakness, difficulty breathing, chest pain, tachycardia, fever, pale skin, rash, ulcers, easy bruising, or petechiae.  

Coding Considerations

Review pertinent Coding Clinics such as:

• AHA Coding Clinic, First Quarter, 2023 p. 23 Pancytopenia due to Acute Myeloid Leukemia
• AHA coding Clinic, Fourth Quarter, 2021 p. 47                                                                                                                                                            o    ICD-10-PC New/Revised Codes: Section 0-Medical and Surgical: Extraction of Bone Marrow from Other Sites
• AHA Coding Clinic, Third Quarter, 2022 p. 22 Neutropenic Fever with Pancytopenia due to Chemotherapy
• AHA Coding Clinic, Third Quarter, 2020 p. 24 Anemia, Thrombocytopenia and Neutropenia
• AHA Coding Clinic, First Quarter, 2019 p. 16 Pancytopenia due to Acute Myelogenous Leukemia
• AHA Coding Clinic, Fourth Quarter, 2014, p. 22 Neutropenic Fever, with Anemia and Thrombocytopenia

Excludes1 notes identifies that pancytopenia cannot be coded with the following:

• Bone marrow infiltration (D61.82)
• Congenial (pure) red cell aplasia (D61.01)
• Hairy cell leukemia (C91.4)
• HIV Disease (B20-)
• Leukoerythroblastic anemia (D61.82)
• Myeloproliferative disease (D47.1)

Excludes2 notes identifies:

• Pancytopenia with myelodysplastic syndromes (D46.-) 
• Antineoplastic chemotherapy induced pancytopenia (D61.810) with aplastic anemia due to antineoplastic chemotherapy (D61.1) 
• Other drug-induced pancytopenia (D61.811) with aplastic anemia due to drugs (D61.1) 

Other constitutional aplastic anemia (D61.09), is assigned if the pancytopenia is congenital rather than due to chronic disease.  Many pancytopenia codes map to an HCC and can affect Risk Adjustment scores. 

CDI Practice Considerations

Pancytopenia is a manifestation of another underlying condition. When reviewing for etiology it can be grouped into three categories: decreased production (central type), bone marrow infiltration/replacement or increased destruction (peripheral type). Review the record closely and query when necessary. Some examples include: 

• When pancytopenia is drug induced, ICD-10-CM distinguishes whether it is due to antineoplastic chemotherapy (D61.810) or other drug (D61.811), both of which are designated as MCC, potentially impacting MS-DRG assignment.  
• When pancytopenia is NOT drug induced, ICD-10-CM distinguishes it as other pancytopenia (D61.818), designated as a CC, potentially impacting MS-DRG assignment. Be aware per Coding Clinic, this includes cases when pancytopenia is due to Acute Myeloid Leukemia (AML). 
• Sequencing of principal diagnosis:  

              o     The Official Guidelines for Coding and Reporting for anemia associated in malignancy (I.C.2.c.1) does not apply                       to pancytopenia, as pancytopenia encompasses more than anemia. Therefore, when patients are admitted with                     pancytopenia due to a malignancy, AND the pancytopenia is the focus of the admission/care/treatment, the                             pancytopenia would be assigned as principal diagnosis.  

              o    When the admission/encounter is for management of anemia documented as “pancytopenia due to                                                 chemotherapy”, D61.810 is assigned for pancytopenia caused by cancer-fighting drugs. In cancer patients,                                 pancytopenia usually occurs due to bone marrow suppression from chemotherapy. 

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