D46.20

Billable

Refractory anemia with excess of blasts, unspecified

HCC Category Mapping

V28HCC 19 — Lymphoma and Other Cancers

0.105

V24HCC 46 — Severe Hematological Disorders

0.666

ESRDHCC 46 — Severe Hematological Disorders

0.000

RxHCCHCC 19 — Lymphoma and Other Cancers

0.000

What This Code Means

A bone marrow disorder where red blood cells cannot be produced normally and there is an excess of immature blood cells, but the specific percentage is not documented.

Coding Tips

•Use this code only when the percentage of blasts is not specified
•If blast percentage is documented, use the more specific codes D46.21 or D46.22

Clinical Significance

Refractory anemia with excess of blasts, unspecified, represents a higher-risk myelodysplastic syndrome subtype where immature blast cells are elevated in the bone marrow but the specific percentage is not documented. This condition carries a significantly increased risk of transformation to acute myeloid leukemia compared to lower-grade myelodysplastic syndrome subtypes.

Documentation Requirements

✓Documentation should include bone marrow biopsy confirming elevated blast percentage, though the specific count is not available for subtyping.
✓A provider query should be initiated to determine the exact blast percentage (5-9% for RAEB-1 or 10-19% for RAEB-2) for more specific coding.
✓Document cytogenetic findings, transfusion requirements, and disease trajectory.

Commonly Confused Codes

D46.21 (refractory anemia with excess blasts 1, 5-9% blasts) and D46.22 (refractory anemia with excess blasts 2, 10-19% blasts) are more specific and should be used when the blast percentage is documented.D46.0 (refractory anemia without ring sideroblasts) indicates lower blast counts.C92.00 (acute myeloblastic leukemia) is used when blasts reach 20% or higher.

Code Hierarchy

└D46Myelodysplastic syndromes └D46.2Refractory anemia with excess of blasts [RAEB]└D46.20Refractory anemia with excess of blasts, unspecified

└D46.20Refractory anemia with excess of blasts, unspecified