New Diagnosis Codes Related to Transfusions
Hemolytic Transfusion Reaction (999.60-999.6, 999.70-999.80, and 999.83-999.85)
This year, the diagnoses related to a hemolytic transfusion reaction (due to either ABO/non-ABO or Rh/non-Rh Incompatibility) have been expanded. Hemolytic Transfusion Reactions (HTRs) are defined based on the timing of the reaction. Patients can suffer from a(n):
1. Acute Hemolytic Transfusion Reaction (AHTR) – Occurs within 24 hours of a transfusion
2. Delayed Hemolytic Transfusion Reaction (DHTR) – Occurs between 24 hours and 28 days of a transfusion
These conditions were previously reported as 999.6, ABO incompatibility reaction, or as 999.7, Rh incompatibility reaction. Codes 999.6 and 999.7 will no longer be valid as of October 1, 2010.
Hemochromatosis (275.01 thru 275.09)
Hemochromatosis is an iron metabolic disorder, and the new codes establish why the iron is not metabolizing. Hemochromatosis may be hereditary, due to a repeated red blood cell transfusion, or caused by other iron metabolic disorders. These conditions were previously reported as 275.0, disorders of iron metabolism. Code 275.0 has been deleted.
Other Transfusion-Related Diagnoses (Fluid Overload and Secondary Thrombocytopenia)
Code 276.6, fluid overload, has been deleted this year. Providers must now distinguish between fluid overload caused by a transfusion of blood or blood components, and a fluid overload caused by other reasons. The new diagnosis codes are as follows:
• 276.61, Transfusion Associated Circulatory Disorder (TACO) – Occurs during or within 6 hours of a transfusion
• 276.69, Other fluid overload
Code 287.4, secondary thrombocytopenia, has been deleted this year. Posttransfusion purpura (PTP), a condition characterized by a sudden severe thrombocytopenia (platelet count < 10,000), can occur 5 to 12 days after a transfusion. For secondary thrombocytopenia that develops as a result of a transfusion, report code 287.41, posttransfusion purpura. For secondary thrombocytopenia that develops for reasons other than a transfusion, report code 287.49, other secondary thrombocytopenia.
Nonhemolytic Transfusion Reaction
Patients can develop a post transfusion fever when passively transfused cytokines react with recipient antibodies and transfused leukocytes. In this situation, there is no destruction of red blood cells, but the patient experiences fever and chills within 4 hours of the transfusion. To report this condition, use code 780.66, febrile nonhemolytic transfusion reaction (FNHTR).