Hematologic and Lymphatic Conditions

Blood Cell Conditions

Primary myelofibrosis, a condition that interferes with the ability of the bone marrow to produce blood cells, is rated under code 7718, below.

Diagnostic Code 7704: Polycythemia vera is the opposite of anemia. Instead of having too few red blood cells, the bone marrow produces too many red blood cells. This can cause shortness of breath, bleeding, dizziness and many serious symptoms. If this condition causes a serious side effect like high blood pressure, gout, a stroke or a blood clot, then those conditions are rated separately. They must be serious enough to cause a significant decrease in the ability to function in order to qualify for a rating. For example, slightly high blood pressure that does not limit the amount of activity a person can do is not enough for high blood pressure to be rated separately. Polycythemia vera is not curable but can be treated.

If it requires a peripheral blood or bone marrow stem-cell transplant, or treatment with chemotherapy (including myelosuppressants), then it is rated 100%. This 100% rating continues for 6 months following the last treatment or discharge from the hospital. The condition is then reevaluated and re-rated.

In order to control the red blood cell count, if it requires a phlebotomy to be performed 6 or more times each year or if it requires molecularly-targeted therapy, then it is rated 60%.

If it requires a phlebotomy to be performed 4 or 5 times each year, or if it requires continuous therapy (with biologic or myelosuppresive agents, like interferon) to keep the platelet count under 200,000 or the white blood cell count under 12,000, then it is rated 30%.

If it requires a phlebotomy 3 or less times each year, or if it requires intermittent biologic therapy (like interferon) in order to maintain appropriate levels, then it is rated 10%.

If the condition turns into leukemia, then it is rated as leukemia under code 7703.

Diagnostic Code 7702: Agranulocytosis (also known as granulopenia and agranulosis) is a condition where the bone marrow does not produce enough white blood cells. This significantly decreases the body’s immune system and makes the body very vulnerable to infection and disease.

A few important things to know before discussing the ratings: Neutrophils are a type of white blood cell that are essential to the immune system. There are two main different types of treatment that can be used to maintain an acceptable level of neutrophils in the blood. In medical reports, this will be noted as the ANC (absolute neutrophil count), and will include a volume count in microliters (µl), for example, ANC = 750/µl.

One type of treatment used to keep the ANC up is myeloid growth factors. These are agents that help produce blood cells. The most common myeloid growth factors are granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF). The second most common type of treatment used to boost the ANC is immunosuppressive therapy—basically drugs, like cyclosporine, that suppress the immune system.

Now the ratings:

If the condition requires a bone marrow transplant, it is rated 100%. This 100% rating continues for 6 months following the transplant. The condition will then be reevaluated and re-rated based on any remaining symptoms.

Whether or not a transplant is performed, if infections occur at least once every 6 weeks each year on average, it is rated 100%.

If continuous immunosuppressive therapy or intermittent myeloid growth factors are needed to keep the ANC between 500/µl and 1,000/µl, or if an infection occurs at least once every 3 months each year on average, then it is rated 60%.

If intermittent myeloid growth factors are needed to keep the ANC above1,000/µl, or if an infection occurs at least once a year on average, then it is rated 30%.

If intermittent myeloid growth factors are needed to keep the ANC at 1,500/µl or above, or if the condition at least requires continuous medication, like antibiotics, then it is rated 10%.

Diagnostic Code 7725: Myelodysplastic syndromes are conditions in which the body does not produce enough of all types of blood cells.

If the condition requires a bone marrow or peripheral blood stem cell transplant, or if it requires chemotherapy, it is rated 100%. This 100% rating continues for 6 months following the last treatment or discharge from the hospital. It will then be reevaluated and re-rated by the VA.

If the condition requires 4 or more blood or platelet transfusions each year, or if it causes 3 or more infections that require hospitalization each year, it is rated 60%.

If the condition requires 1 to 3 blood or platelet transfusions each year, or if it causes 1 or 2 infections that require hospitalization each year, or if it requires ongoing biologic therapy, or if it requires erythropoiesis stimulating agent (ESA) for 12 weeks or less each year, it is rated 30%.

If the condition develops into leukemia, it is rated under code 7703.

Platelets

Platelets are small bits of cells in the blood that help stop bleeding and form blood clots.

Diagnostic Code 7705: Thrombocytopenia is a condition where the platelet count in the blood is low. The normal amount of platelets in a microliter of blood is between 150,000 to 450,000.

If the platelet count remains at 30,000 or less despite treatment, it is rated 100%. A 100% rating is also given if the condition is chronic refractory thrombocytopenia (a specific type of thrombocytopenia) and it requires chemotherapy. This 100% rating continues for 6 months following the last chemotherapy treatment and is then reevaluated and re-rated based on any remaining symptoms.

A 70% rating is given if the patient had been hospitalized at least once in the past for severe bleeding that was treated with immune globulin, corticosteroids, and platelet transfusions, and the condition currently requires immunosuppressive therapy or the platelet count is between 30,000 and 50,000.

A 30% rating is given if the platelet count is between 30,000 and 50,000, and there is mild bleeding that requires either oral corticosteroids or immune globulin injections.

A 10% rating is given if the platelet count is between 30,000 and 50,000,but no treatment is required.

A 0% rating is given if the platelet count is above 50,000, or if the immune thrombocytopenia is in remission.

If a splenectomy is performed, it is rated separately under code 7706.

Diagnostic Code 7718: Essential thrombocythemia is a disease which causes the body to produce too many platelets, and primary myelofibrosis is a condition that interferes with the ability of the bone marrow to produce blood cells, thus resulting in abnormal cell and platelet levels. Both are rated under this code.

If the condition requires a peripheral blood or bone marrow stem cell transplant, chemotherapy, or interferon treatments, it is rated 100%. This 100% rating continues for 6 months following discharge from the hospital or following the last treatment. It is then reevaluated and re-rated by the VA.

A 100% rating is also given for the entire time the condition requires continuous myelosuppressive therapy.

If the condition requires myelosuppressive therapy, chemotherapy, or interferon therapy to keep the platelet count less than 500,000,000,000/L (a.k.a. 500x109/L), it is rated 70%.

If it requires myelosuppressive therapy, chemotherapy, or interferon therapy to keep the platelet count between 200,000 and 400,000 or to keep the white blood cell count between 4,000 and 10,000, it is rated 30%. A 0% rating is given if the condition is asymptomatic.

If the condition turns into leukemia, it is then not rated under this code, but under code 7703.

The Spleen

The spleen is an organ that filters the blood and removes old red blood cells.

Diagnostic 7706: If the spleen is completely or partially removed, then it is rated 20%. If there are any complications, then those symptoms are rated separately.

Diagnostic Code 7707: All other spleen conditions are rated under this code. This code does not have its own rating system but is rated analogously with the symptoms the spleen condition causes. So if the spleen does not filter properly and causes a heart condition, then it would be rated under that heart condition. The final code would look like this: 7707-4593. The first four-digit code defines the condition as a spleen condition and the second four-digit code is how the condition is rated.

Tuberculosis of the Lymph Nodes

Diagnostic Code 7710: Tuberculous adenitis (or “scrofula”) is a tuberculous infection of the lymph nodes in the neck. This condition is rated 100% while it is active. This 100% rating will continue for 1 year, after which the condition will be reexamined and rated based on the lasting symptoms or complications.