It is important to distinguish between anemia due to chronic blood loss and anemia due to acute blood loss, because the two conditions have entirely different codes in ICD-9-CM. Acute blood-loss anemia results from a sudden, significant loss of blood over a brief period of time. It may occur due to trauma such as laceration, or a rupture of the spleen or other injury of abdominal viscera, where no external blood loss is noted. A diagnosis of acute blood-loss anemia should be supported by documented evidence of the condition, such as a sustained, significant lowering of the hemoglobin level and/or hematocrit. Â Â Â Â Â Acute blood-loss anemia may occur following surgery, but it is not necessarily a complication of the procedure and should not be coded as a postoperative complication unless the physician identifies it as such. Many surgical procedures, such as hip replacement, routinely involve a considerable amount of bleeding as an expected part of the operation. This may or may not result in anemia; a code for anemia should be assigned only when the anemia is documented by the physician. If, in the physician's clinical judgment, surgery results in an expected amount of blood loss and the physician does not describe the patient as having anemia or a complication of surgery, do not assign a code for the blood loss. If a postoperative blood count is low enough to suggest anemia, it is appropriate to ask the physician whether a diagnosis of anemia should be added. The coder should not assume, however, that mention of blood loss and/or transfusion during surgery is an indication that anemia is present.
Ac Blood Loss Anemia is reallly the physician's call. Some hospitals establish guidelines - with physician input - regarding at what point they consider a diagnosis of Ac Blood Loss Anemia. It can be established as a department policy.
But I usually watch my H&H's and blood administrations. I know some hospitals watch the "over use" of transfusions. In that case, any "blood-boosting" products (Epogen, etc.) being administered are considered treatment. Also the constant monitoring (CBC's and H&H's) are considered treatment. So if I see serial H&H's or CBC's I may query for medical necessity.
Comments
Below I have posted Faye Brown's guidelines.
Renee
Linda Renee Brown, RN, CCRN, CCDS
Clinical Documentation Specialist
Arizona Heart Hospital
It is important to distinguish between anemia due to chronic blood loss and anemia due to acute blood loss, because the two conditions have entirely different codes in ICD-9-CM. Acute blood-loss anemia results from a sudden, significant loss of blood over a brief period of time. It may occur due to trauma such as laceration, or a rupture of the spleen or other injury of abdominal viscera, where no external blood loss is noted. A diagnosis of acute blood-loss anemia should be supported by documented evidence of the condition, such as a sustained, significant lowering of the hemoglobin level and/or hematocrit.
     Acute blood-loss anemia may occur following surgery, but it is not necessarily a complication of the procedure and should not be coded as a postoperative complication unless the physician identifies it as such. Many surgical procedures, such as hip replacement, routinely involve a considerable amount of bleeding as an expected part of the operation. This may or may not result in anemia; a code for anemia should be assigned only when the anemia is documented by the physician. If, in the physician's clinical judgment, surgery results in an expected amount of blood loss and the physician does not describe the patient as having anemia or a complication of surgery, do not assign a code for the blood loss. If a postoperative blood count is low enough to suggest anemia, it is appropriate to ask the physician whether a diagnosis of anemia should be added. The coder should not assume, however, that mention of blood loss and/or transfusion during surgery is an indication that anemia is present.
But I usually watch my H&H's and blood administrations. I know some hospitals watch the "over use" of transfusions. In that case, any "blood-boosting" products (Epogen, etc.) being administered are considered treatment. Also the constant monitoring (CBC's and H&H's) are considered treatment. So if I see serial H&H's or CBC's I may query for medical necessity.