Pathology/Lab Coding Alert

Use fifth digit to distinguish hemolysis, other transfusion reactions.

Stating "ABO (or Rh) incompatibility reaction" won't be enough for accurate diagnosis coding starting Oct. 1. You'll need to add information about whether the reaction is an acute or delayed hemolytic reaction or due to some other type of incompatibility.

Here's why: ICD-9 2011 will render the following codes invalid and require you to use one of the new codes from Table 1 below instead:

999.6 -- ABO incompatibility reaction

999.7 -- Rh incompatibility reaction.

The table shows that you'll also have expanded codes in subcategory 999.8 (Other infusion and transfusion reaction).

Note Type and Timing for Proper Code Choice

Hemolysis, involving red blood cell rupture, is just one type of transfusion reaction that might occur due to an incompatibility between the donor and recipient blood. In Table 1, you'll see new ICD-codes to distinguish hemolytic reactions from "other" and "unspecified" transfusion reactions.

Tip: Remember that "other" means the documentation spells out some specific condition that isn't described by a more detailed ICD-9 code, while "unspecified" means that the documentation doesn't explicitly define the condition," says William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

The new codes also add specificity to reporting hemolytic reaction's timing (acute or delayed) as follows:

Acute: An acute hemolytic transfusion reaction (AHTR) involves "accelerated destruction of red blood cells less than 24 hours after transfusion," according to Mikhail Menis, PharmD, MS, of the FDA CBER, in his presentation at the ICD-9-CM Coordination and Maintenance Committee Meeting. As you can see in Table 1, proposed codes 999.62, 999.72, 999.77, and 999.84 all specify acute.

Delayed: As opposed to acute, delayed hemolytic transfusion reaction (DHTR) refers to "accelerated destruction of red blood cells which usually manifests 24 hours to 28 days (one month) after a transfusion," Menis noted. Proposed "delayed" codes include 999.63, 999.73, 999.78, and 999.85.

Table Focuses New Incompatibility Codes

Table 1 lists the proposed transfusion reaction for ICD-9 2011 as follows: