Acute Blood Loss Anemia
Hi,
We are looking to develop some guidelines for sending queries; clinical validation and also for an initial diagnosis of ABLA. Does anyone have any they are willing to share? We have been receiving denials for ABLA and finding it a difficult diagnosis to defend using the criteria from the auditors.
Comments
We look for a drop of hemoglobin of 2 or greater or 15% or greater not attributable to hemodilution for a diagnosis of ABLA. With this though, still not having great success with UHC appeals.
Sending you some information from ACDIS Pro on anemia cgoewey:
Symptoms vary depending on the severity of the anemia or how rapidly the condition developed. Mild anemia, especially if developing slowly, may not demonstrate any symptoms or show symptoms only with exertion. More severe anemia may demonstrate symptoms even when at rest. Symptoms are more severe when mild or severe anemia develops rapidly, such as with blood loss.
Fatigue, weakness, and paleness often are seen in mild anemia. Severe anemia may result in faintness, dizziness, increased thirst, sweating, weak and rapid pulse, and rapid breathing. Severe anemia may cause painful lower leg cramps during exercise, shortness of breath, and chest pain.
The symptoms may also give clues to the cause of the anemia. Black tarry stools, blood in the urine or stool, hemoptysis, or recent blood loss due to trauma or surgery suggest anemia due to blood loss. Dark urine or jaundice suggest hemolytic anemia. A burning or prickling feeling in the hands or feet may indicate vitamin B12 deficiency.
A complete blood count (CBC) is drawn to measure hemoglobin. Other information (RBC shape, size, and color; ferritin levels) obtained from the CBC may help identify the underlying etiology.
Mean corpuscular volume (MCV) describes the average size of red blood cells. Microcytic anemia, with a decreased MCV (< 80 fL), demonstrates a dysfunction in cellular hemoglobin synthesis. Iron deficiency and anemia of chronic disease often demonstrate a decreased MCV.
Macrocytosis, or a high MCV (>100 fL), can be due to deficiencies of B12, folate and copper, myelodysplastic syndrome, aplastic anemia, and adverse reactions that interfere with DNA synthesis. Hemolytic anemias may also contribute.
Normocytic anemia, with a normal MCV (80–100), is often attributed to nutrient deficiencies, CKD and other chronic diseases, cancer, and endocrine disorders.
Hemoglobin Levels Indicating Anemia (World Health Organization Criteria)
Generally, in the United States the thresholds are a little higher:
Treatment will vary, depending on the etiology. For vitamin- or iron-deficiency anemias, the treatment may only include supplements and dietary changes. Otherwise, identification of the underlying condition is required so the correct treatment may be applied. Applicable interventions may include medications and transfusions. Hemoglobin and hematocrit (Hb/Hct) levels are monitored.
When anemia is due to acute blood loss, the immediate focus is stabilizing the patient and ensuring adequate tissue perfusion and oxygen, which may include transfusions. Once the patient is stabilized, RBC, hemoglobin, and iron levels are monitored.
Many hospital blood banks have set restrictive transfusion thresholds to address patients with anemia who are hemodynamically stable. The decision to transfuse is based on patient history, presentation, and applicable alternative therapies. Thresholds can vary depending on the patient population. A blood transfusion is not required to support the diagnosis of anemia.
Providers should be educated that D62, Acute blood loss anemia, is not a complication that will impact CMS quality reporting. Complication codes related to surgical blood loss are described as postoperative hemorrhage and hematoma.
When blood loss is inherent to the procedure or is anticipated, it should not be reported as a complication. Providers should avoid the wording postoperative or postprocedural, as such may lead to the assignment of a complication code when it is not appropriate to do so. The provider should clearly note the factors contributing to the blood loss, e.g., “due to trauma.”
It is common for providers to describe superficial spreading of blood (such as after percutaneous vascular access procedures) or bruising around an incision as a “hematoma” (a collection of blood typically forming a mass). Very often there is little or no change in the typical care of the patient post-procedure. A seroma (a collection of serous fluid) can be mischaracterized in the same way. A query may be needed to clarify the significance as well as whether it is considered a complication of the procedure.
Anemia sequenced as the principal diagnosis maps to DRG 811–812 (Red Blood Cell Disorders With or Without MCC).
Patients may demonstrate an acute blood loss anemia on an already existing chronic anemia. In such an instance, it is helpful to compare to baseline levels if available. Suggested criteria:
The provider must clarify the etiology of anemia for patients admitted with a neoplasm and receiving chemotherapy. If the anemia is linked to the neoplasm, the neoplasm is sequenced first. If the chemotherapy is the underlying etiology, the anemia is sequenced first.
For those patients admitted with anemia and a diagnosis of GI bleed, the record should be reviewed to establish the most appropriate principal diagnosis. If the GI bleed was previously diagnosed and the focus of care is to treat the anemia, the anemia would be the principal diagnosis. Conversely, if a patient is admitted with anemia and the workup during the encounter identifies a source of bleeding, then the GI bleed would be sequenced as the principal diagnosis.
Deanne,
Thank you for taking the time to post this information :)