Chapter 3 — Diseases of the Blood and Blood-forming Organs
Reserved for future guideline expansion — so the conventions, the general guidelines and the Tabular List notes do all the work, together with the Chapter 2 and Chapter 1 rules that control several Chapter 3 codes.
The FY 2027 guidelines carry no chapter-specific guidelines for Chapter 3 (D50-D89). The entry reads: reserved for future guideline expansion. That is not a gap you may fill with judgement — it means the conventions in Section I.A, the general guidelines in Section I.B, the instructional notes in the Tabular List, and Sections II, III and IV carry the whole weight of coding this chapter.
The Chapter 3 codes that other guidelines control#
| Code | Sequencing rule | Guideline |
|---|---|---|
D63.0 Anemia in neoplastic disease | Encounter for management of an anemia associated with the malignancy, treating only the anemia → the malignancy is sequenced first, then D63.0 | I.C.2.c.1, I.C.2.l.4 |
| Anemia due to an adverse effect of chemotherapy or immunotherapy | The anemia is sequenced first, then the neoplasm, then T45.1X5- | I.C.2.c.2 |
| Anemia due to an adverse effect of radiotherapy | The anemia first, then the neoplasm, then Y84.2 | I.C.2.c.2 |
D59.31 Infection-associated hemolytic-uremic syndrome, associated with HIV disease | D59.31 is the principal diagnosis, followed by B20 | I.C.1.a.2.b |
D59.31 associated with sepsis | D59.31 is the principal diagnosis; the underlying systemic infection and any other conditions such as severe sepsis are secondary | I.C.1.d.9 |
| Coagulation and platelet disorders on long-term anticoagulation | Z79.01 / Z79.02 long-term use of anticoagulants or antithrombotics — a status code under the Chapter 21 rules for long-term drug therapy | I.C.21.c.3 |
Practice questions#
Q1What do the FY 2027 guidelines say about chapter-specific guidelines for Chapter 3?
- AThey were deleted effective October 1, 2017
- BThe entry reads “reserved for future guideline expansion”
- CThey are combined with Chapter 4
- DThey appear only in Appendix I
Show answer & rationale
Correct answer: B. The entry reads “reserved for future guideline expansion”
Rationale. The FY 2027 guidelines list Chapter 3 (D50-D89) with the single line “Reserved for future guideline expansion”. Chapters 8 and 11 carry the same entry. This is not the same as a deleted guideline: Section II.E and Section I.C.18.f are marked as deleted, with the effective date of deletion.
Q2A patient with active multiple myeloma is admitted for transfusion of anemia documented as due to the myeloma. Only the anemia is treated. What is sequenced first?
- A
D63.0 - BThe multiple myeloma code
- C
D64.9 - D
Z51.11
Show answer & rationale
Correct answer: B. The multiple myeloma code
Rationale. Guideline I.C.2.c.1 provides that when the admission or encounter is for management of an anemia associated with the malignancy, and the treatment is only for the anemia, the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis followed by the appropriate code for the anemia, such as D63.0. Chapter 3 has no guideline of its own that would change this.
Q3Hemolytic-uremic syndrome associated with sepsis is the reason for admission. What is the principal diagnosis?
- AThe underlying systemic infection
- B
D59.31 - C
R65.20 - DEither the infection or
D59.31, at the coder's discretion
Show answer & rationale
Correct answer: B. D59.31
Rationale. Guideline I.C.1.d.9 states that if the reason for admission is hemolytic-uremic syndrome that is associated with sepsis, D59.31 infection-associated hemolytic-uremic syndrome is assigned as the principal diagnosis, with codes for the underlying systemic infection and any other conditions such as severe sepsis assigned as secondary diagnoses. This is one of the few situations in which a code outranks the systemic infection in a sepsis case.
Q4With no chapter-specific guidelines, what governs code selection in Chapter 3?
- ACoder judgement
- BOnly Section II and Section III
- CThe Section I.A conventions, the Section I.B general guidelines, the Tabular List instructional notes, and Sections II, III and IV
- DAHA Coding Clinic only
Show answer & rationale
Correct answer: C. The Section I.A conventions, the Section I.B general guidelines, the Tabular List instructional notes, and Sections II, III and IV
Rationale. A reserved chapter is not an unregulated chapter. Section I states that the conventions and instructions of the classification take precedence over the guidelines, and the general guidelines in Section I.B apply to the whole classification. Where Section I.C is silent, those sources plus the reporting rules in Sections II, III and IV carry the full weight.
Q5A patient on long-term warfarin therapy for atrial fibrillation is seen for routine monitoring. Which additional status code category applies?
- A
Z86 - B
Z79 - C
Z88 - D
Z91.1-
Show answer & rationale
Correct answer: B. Z79
Rationale. Category Z79, long-term (current) drug therapy, indicates a patient's continuous use of a prescribed drug for the long-term treatment of a condition or for prophylactic use. Section I.C.21.c.3 directs that a code from Z79 be assigned where a medication is given for an extended period as a prophylactic measure or as treatment of a chronic condition, and that it not be assigned for medication given briefly to treat an acute illness. Z79 is not for patients with drug addictions and not for detoxification or maintenance programmes.
Scenarios#
An office record documents iron deficiency anemia secondary to chronic gastrointestinal blood loss, and separately documents an acute exacerbation with a haemoglobin drop requiring transfusion. Both the acute and the chronic states are documented, and the Alphabetic Index provides separate subentries at the same indentation level.
Show coded answer & rationale
| Seq | Code | Description |
|---|---|---|
| 1 | 1 | the code for the acute form, sequenced first |
| 2 | 2 | the code for the chronic form |
Rationale. With no chapter-specific guideline, Section I.B.8 governs: where the same condition is described as both acute (subacute) and chronic and separate subentries exist in the Alphabetic Index at the same indentation level, code both and sequence the acute code first. Check first for a combination code — Section I.B.9 requires that a combination code be assigned alone where it fully identifies the conditions involved.
Guideline: Section I.B.8, I.B.9
A coder selects a code in category D50-D89 and the Tabular List shows an Excludes1 note naming a second code that the record also appears to support. The two conditions documented are, on review of the record, clearly unrelated to each other.
Show coded answer & rationale
| Seq | Code | Description |
|---|---|---|
| 1 | Both | both codes may be reported, because the two conditions are unrelated |
Rationale. Convention I.A.12.a governs whether or not a chapter has its own guidelines. An Excludes1 note normally means the two codes may never be reported together, but the guideline provides an exception for the circumstance in which the two conditions are unrelated to each other. If it is not clear whether they are related, the provider is queried.
Guideline: Section I.A.12.a
Primary sources#
- ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027CMS — the source document for every page on this site (effective 1 Oct 2026)
- NCHS ICD-10-CM files — Tabular List, Index, POA exempt listOfficial code files, addenda and the list of codes exempt from POA reporting
- ICD-10 Coordination and Maintenance CommitteeWhere code proposals are debated; agendas, summaries and meeting materials
- CMS ICD-10 homeCode sets, transition guidance and Medicare coding policy
- AHA Coding ClinicOfficial coding advice from the AHA Central Office — subscription required
- HHS OIG Work PlanActive audit topics — useful for prioritising internal coding audits
- MEDESUN Medical Coding AcademyTraining, credential preparation and audit services by the author