D46.22

Billable

Refractory anemia with excess of blasts 2

HCC Category Mapping

V28HCC 17 — Metastatic Cancer and Acute Leukemia

0.368

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 at 10-19% of the bone marrow.

Coding Tips

•Requires documentation of blast percentage between 10-19%
•This subtype carries higher risk of progression to acute leukemia than D46.21

Clinical Significance

Refractory anemia with excess of blasts 2 (RAEB-2) is the highest-risk myelodysplastic syndrome subtype before transformation to acute myeloid leukemia, with 10-19% blasts in the bone marrow. Median survival is approximately 10-16 months, and the risk of leukemic transformation approaches 40-50%, making this a critical diagnosis requiring urgent treatment decisions.

Documentation Requirements

✓Documentation must include bone marrow biopsy confirming blast percentage between 10-19%, cytogenetic analysis, and International Prognostic Scoring System score.
✓Treatment plan (hypomethylating agents, intensive chemotherapy, stem cell transplant eligibility) should be documented.
✓Peripheral blood Auer rods, if present, also qualify as RAEB-2 regardless of blast count.

Commonly Confused Codes

D46.21 (RAEB-1, 5-9% blasts) has a lower blast count and better prognosis.C92.00 (acute myeloblastic leukemia, not in remission) is used when blasts reach 20% or higher, representing leukemic transformation.D46.20 (excess blasts, unspecified) should not be used when blast percentage is documented.

Code Hierarchy

└D46Myelodysplastic syndromes └D46.2Refractory anemia with excess of blasts [RAEB]└D46.22Refractory anemia with excess of blasts 2

└D46.22Refractory anemia with excess of blasts 2