D45
BillablePolycythemia vera
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D45 an HCC code?
Yes. D45 maps to Melanoma and Other Skin Cancers under the CMS-HCC V28 risk adjustment model (and Coagulation Defects and Other Specified Hematological Disorders under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for D45
For D45 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed D45 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D45 is the ICD-10-CM diagnosis code for polycythemia vera. Polycythemia vera is a blood disorder where the bone marrow produces too many red blood cells, causing the blood to become thick and potentially leading to blood clots or bleeding problems. This is a chronic condition that requires ongoing monitoring and treatment. D45 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (d37-d48).
Under the CMS-HCC V28 risk adjustment model, D45 maps to Melanoma and Other Skin Cancers (HCC 23) with a community, non-dual, aged base RAF weight of 0.251. Under the older CMS-HCC V24 model, D45 maps to Coagulation Defects and Other Specified Hematological Disorders (HCC 48) with a community, non-dual, aged base RAF weight of 0.209. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
D45 is the only code needed for polycythemia vera diagnosis; do not add additional codes for secondary polycythemia (D75.1) unless explicitly documented as a separate condition. Because D45 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for D45 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •D45 is the only code needed for polycythemia vera diagnosis; do not add additional codes for secondary polycythemia (D75.1) unless explicitly documented as a separate condition
- •When polycythemia vera leads to complications such as thrombosis, stroke, or myocardial infarction, code those conditions separately in addition to D45
Clinical Significance
Polycythemia vera is a chronic myeloproliferative neoplasm characterized by the JAK2 V617F mutation in over 95% of cases, resulting in uncontrolled red blood cell production. This condition significantly increases the risk of thrombotic events (stroke, pulmonary embolism, deep vein thrombosis) and can transform to myelofibrosis or acute myeloid leukemia over time.
Documentation Requirements
- ✓Documentation should include the polycythemia vera diagnosis with supporting laboratory data: elevated hemoglobin/hematocrit, JAK2 mutation status, erythropoietin levels, and bone marrow biopsy findings.
- ✓Current treatment (phlebotomy, hydroxyurea, aspirin) should be documented.
- ✓Note any thrombotic or hemorrhagic complications and transformation risk factors.
Commonly Confused Codes
- •D75.1 (secondary polycythemia) is used for elevated red blood cells due to a known cause such as chronic hypoxia, smoking, or erythropoietin-producing tumors.
- •D47.1 (chronic myeloproliferative disease) covers other myeloproliferative neoplasms.
- •D75.0 (familial erythrocytosis) is a hereditary form distinct from polycythemia vera.