The ICD-10-CM code for anemia with no type documented is D64.9, Anemia, unspecified. Once the provider names the type or cause, such as iron deficiency, B12 deficiency, chronic kidney disease or chemotherapy, a more specific code replaces it.
Anemia is coded across categories D50 to D64, and several of the most common situations come with sequencing instructions. Anemia in chronic kidney disease needs the kidney disease coded first. Anemia caused by chemotherapy and anemia in cancer follow different orders. Getting the order wrong is as common as picking the wrong code.
This guide groups the codes by cause, explains the sequencing rules, and shows when more than one anemia code belongs on the same claim. If a work-up also finds a raised white count, see our leukocytosis ICD-10 guide.
Key Takeaways
- D64.9 is for anemia with no type stated. Replace it as soon as the provider documents the type.
- Code from the provider’s diagnosis. A low hemoglobin on a lab report is not coded as anemia until the provider diagnoses it.
- Anemia in CKD is D63.1, with the N18 stage code listed first.
- Anemia caused by chemotherapy is D64.81, followed by the neoplasm and T45.1X5-.
- More than one anemia code can be reported when the provider documents more than one type.
Anemia Codes by Cause
| Cause or type | Code | Official title |
|---|---|---|
| Not specified | D64.9 | Anemia, unspecified |
| Iron deficiency, cause not stated | D50.9 | Iron deficiency anemia, unspecified |
| Iron deficiency from chronic blood loss | D50.0 | Iron deficiency anemia secondary to blood loss (chronic) |
| Iron deficiency from another documented cause | D50.8 | Other iron deficiency anemias |
| Pernicious anemia | D51.0 | Vitamin B12 deficiency anemia due to intrinsic factor deficiency |
| Dietary B12 deficiency | D51.3 | Other dietary vitamin B12 deficiency anemia |
| B12 deficiency, type not stated | D51.9 | Vitamin B12 deficiency anemia, unspecified |
| Folate deficiency, dietary | D52.0 | Dietary folate deficiency anemia |
| Folate deficiency from a drug | D52.1 | Drug-induced folate deficiency anemia |
| Acute blood loss | D62 | Acute posthemorrhagic anemia |
| Chronic kidney disease | D63.1 | Anemia in chronic kidney disease |
| Cancer (not chemotherapy) | D63.0 | Anemia in neoplastic disease |
| Other chronic disease | D63.8 | Anemia in other chronic diseases classified elsewhere |
| Chemotherapy | D64.81 | Anemia due to antineoplastic chemotherapy |
A note on D51.1. D51.1 is B12 deficiency anemia due to selective B12 malabsorption with proteinuria, a rare inherited condition. It is not a general code for B12 malabsorption.
Sequencing Rules That Change the Claim
- Anemia in CKD. D63.1 carries a code-first note. List the N18 stage code first, then D63.1.
- Anemia in cancer. When the visit is to manage anemia associated with a malignancy and only the anemia is treated, list the malignancy first, then D63.0.
- Anemia from chemotherapy. When the visit is to treat the anemia, list D64.81 first, then the neoplasm, then T45.1X5- for the adverse effect of antineoplastic drugs.
- Anemia from chronic GI bleeding. Code D50.0 and the source when the provider confirms it. If reflux esophagitis is bleeding, see our gastric reflux ICD-10 guide; an EGD with biopsy is reported with CPT 43239.
- Anemia in pregnancy. Chapter 15 comes first. Use O99.01- with the trimester, followed by the specific anemia code. The rule is the same whether the prenatal visit is billed by an OB/GYN or a certified nurse-midwife.
Reporting More Than One Anemia Code
There is no rule that limits a claim to one anemia code. If the provider documents iron deficiency anemia and anemia in CKD, both D50.9 and D63.1 are reported, with the CKD stage code ahead of D63.1. What you should not do is report D64.9 together with a specific code for the same anemia, because the specific code already describes it.
Do not code anemia from a lab value alone. A low hemoglobin or ferritin supports the provider’s diagnosis, but the coder needs the provider to state anemia, and ideally its type, before a D code is assigned.
Hereditary and Hemolytic Anemias
| Category | Conditions | Example code |
|---|---|---|
| D55 | Anemia due to enzyme disorders, such as G6PD deficiency | D55.0 |
| D56 | Thalassemia | D56.9 when the type is not stated |
| D57 | Sickle cell disorders | D57.1 for sickle-cell disease without crisis |
| D58 | Other hereditary hemolytic anemias | D58.0 for hereditary spherocytosis |
| D59 | Acquired hemolytic anemia | D59.9 when the type is not stated |
Sickle cell crisis codes in D57 include the crisis complication, such as acute chest syndrome, so read the fifth and sixth characters carefully.
What the Note Should Include
- The diagnosis in the provider’s words, with the type when known
- The cause, such as blood loss, CKD, a medication or chemotherapy
- Supporting results the provider relied on, such as CBC indices, ferritin or B12 level
- Symptoms being treated, such as fatigue or weakness
- The plan: iron, B12 injections, transfusion or further work-up
Worked Example
Scenario. A patient with stage 3b chronic kidney disease and iron deficiency is seen for anemia management. The provider documents anemia of CKD with iron deficiency and starts IV iron. Codes: N18.32, D63.1, D50.9. The CKD stage comes first because of the code-first note at D63.1, and the iron deficiency is reported because the provider documents it as a separate type.
Infusion, nephrology or oncology claims coming back for diagnosis order? Steady Medical Billing applies the code-first and sequencing rules for anemia before claims go out.
Frequently Asked Questions
What is the ICD-10 code for anemia?
D64.9, Anemia, unspecified, is used when the provider does not document a type. Specific codes such as D50.9 for iron deficiency anemia should be used when the type is known.
Can I report more than one anemia code?
Yes, when the provider documents more than one type, such as iron deficiency anemia and anemia in CKD. Do not report D64.9 together with a specific code for the same anemia.
How do I code anemia in chronic kidney disease?
List the N18 code for the CKD stage first, then D63.1, Anemia in chronic kidney disease.
What is the code for anemia caused by chemotherapy?
D64.81, Anemia due to antineoplastic chemotherapy, followed by the neoplasm code and T45.1X5- for the adverse effect of antineoplastic drugs.
Do I need lab values to code anemia?
The code is assigned from the provider’s diagnosis, not from lab values. Lab results support the diagnosis and medical necessity, but a coder cannot assign anemia from a low hemoglobin alone.
