ICD-10 Coding for Polycythemia Vera(D45)
Complete ICD-10-CM coding and documentation guide for Polycythemia Vera. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Polycythemia Vera
D45Primary Range
Polycythemia vera
This is the primary code for diagnosing polycythemia vera, a myeloproliferative disorder characterized by increased red blood cell mass.
Other and unspecified diseases of blood and blood-forming organs
Includes secondary polycythemia, which must be differentiated from polycythemia vera.
Key Information: ICD-10 code for polycythemia vera
Essential facts and insights about Polycythemia Vera
Primary ICD-10-CM Code for polycythemia vera
Decision Criteria
clinical Criteria
- Presence of JAK2 mutation and low serum EPO
documentation Criteria
- Detailed lab results and bone marrow biopsy findings
Applicable To
- Primary polycythemia
- Vaquez disease
Excludes
- Secondary polycythemia (D75.1)
Clinical Validation Requirements
- Hgb >16.5 g/dL in men or >16.0 g/dL in women
- HCT >49% in men or >48% in women
- JAK2 V617F mutation positive
- Subnormal serum erythropoietin level
Code-Specific Risks
- Incorrectly coding secondary polycythemia as D45
- Missing documentation of JAK2 mutation
Coding Notes
- Ensure documentation includes all WHO criteria for diagnosis.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Polycythemia Vera to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code D45.
Impact
Clinical: May lead to misdiagnosis., Regulatory: Non-compliance with diagnostic criteria., Financial: Potential claim denials due to incomplete documentation.
Mitigation Strategy
Ensure genetic testing is completed and documented., Review lab results before finalizing diagnosis.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Use D75.1 for secondary causes of polycythemia.
Impact
Failure to document JAK2 mutation can lead to audit issues.
Mitigation Strategy
Ensure all genetic test results are included in patient records.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Polycythemia Vera, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Polycythemia Vera
Use these documentation templates to ensure complete and accurate documentation for Polycythemia Vera. These templates include all required elements for proper coding and billing.
Initial Diagnosis of Polycythemia Vera
Specialty: HematologyRequired Elements
- Hgb and HCT levels
- JAK2 mutation status
- Serum EPO level
- Bone marrow biopsy results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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