What is ICD-10 code D47.4?

D47.4 is the ICD-10-CM diagnosis code for Osteomyelofibrosis. A condition where bone marrow is replaced by fibrous tissue, leading to scarring and reduced blood cell production. It belongs to the ICD-10-CM chapter for neoplasms (c00-d49). D47.4 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. D47.4 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. D47.4 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. D47.4 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for D47.4?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For D47.4, V28 maps to Lymphoma and Other Cancers at RAF 0.105 while V24 mapped to Severe Hematological Disorders at RAF 0.666. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting D47.4?

Distinguish from primary myelofibrosis (PMF) which has its own code; this code is for uncertain behavior classification Bone marrow biopsy showing fibrosis is typically required for diagnosis confirmation Because D47.4 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

D47.4 ICD-10 Code: Osteomyelofibrosis | Lymphoma

ICD-10-CM Code View

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Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupD47.4Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Neoplasms (C00-D49) / Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (D37-D48)

D47.4

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Osteomyelofibrosis

A condition where bone marrow is replaced by fibrous tissue, leading to scarring and reduced blood cell production.

Buddy Insight

Osteomyelofibrosis is characterized by progressive replacement of bone marrow with fibrous tissue, leading to severe cytopenias and extramedullary hematopoiesis in the spleen and liver.

CMS-HCC V28

Mapped

HCC 19

Lymphoma and Other Cancers

RAF 0.105

CMS-HCC V24

Mapped

HCC 46

Severe Hematological Disorders

RAF 0.666

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Mapped

HCC 46

Severe Hematological Disorders

RAF 0.0

RXHCC

Mapped

HCC 16

Multiple Myeloma and Plasma C...

RAF 0.0

Code Trumping

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Code Book Path

Official

D47Other neoplasms of uncertain behavior of lymphoid, hematopoietic and related tissue

D47.4Osteomyelofibrosis

Inclusion Terms

Official

Chronic idiopathic myelofibrosis
Myelofibrosis (idiopathic) (with myeloid metaplasia)
Myelosclerosis (megakaryocytic) with myeloid metaplasia
Secondary myelofibrosis in myeloproliferative disease

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for D47.4 in this effective period.

Related Child Codes

Official

D47.0Mast cell neoplasms of uncertain behavior

D47.1Chronic myeloproliferative disease

D47.2Monoclonal gammopathy

D47.3Essential (hemorrhagic) thrombocythemia

D47.9Neoplasm of uncertain behavior of lymphoid, hematopoietic and related tissue, unspecified

Includes

Official

ICD-10-CM does not list Includes notes for D47.4 in this effective period.

Excludes 1

Official

acute myelofibrosis (C94.4-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for D47.4 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for D47.4 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for D47.4 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation must include bone marrow biopsy demonstrating fibrosis (reticulin and/or collagen fibrosis grading), peripheral blood counts showing cytopenias or leukoerythroblastic picture, and spleen size.

Document constitutional symptoms, transfusion requirements, and JAK2/CALR/MPL mutation status.

The Dynamic International Prognostic Scoring System risk score should be calculated and documented.

MEAT Support

HCC Buddy guidance

Document constitutional symptoms, transfusion requirements, and JAK2/CALR/MPL mutation status.

The Dynamic International Prognostic Scoring System risk score should be calculated and documented.

Audit Caution

HCC Buddy guidance

Distinguish primary myelofibrosis from secondary myelofibrosis that develops from polycythemia vera or essential thrombocythemia.

Bone marrow biopsy is essential for diagnosis and should demonstrate significant fibrosis.

Do not confuse with aplastic anemia (D61.x), which has a hypocellular marrow rather than fibrotic marrow.

Common Mistakes

HCC Buddy guidance

D47.1 (chronic myeloproliferative disease) is a broader category that may include myelofibrosis.

D75.81 (myelofibrosis) may be used for secondary myelofibrosis.

D45 (polycythemia vera) or D47.3 (essential thrombocythemia) may evolve into secondary myelofibrosis, which should be coded to this code if the marrow demonstrates fibrosis.

C94.40 (acute panmyelosis with myelofibrosis) is an acute presentation.

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is D47.4 an HCC code?

Yes. D47.4 maps to Lymphoma and Other Cancers under the CMS-HCC V28 risk adjustment model (and Severe Hematological Disorders under V24).

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 16, Multiple Myeloma and Plasma Cell Neoplasms

0.000

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 D47.4

For D47.4to 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 D47.4 during that encounter, not just copy-forwarded from a problem list.

What This Code Means

D47.4 is the ICD-10-CM diagnosis code for osteomyelofibrosis. A condition where bone marrow is replaced by fibrous tissue, leading to scarring and reduced blood cell production. D47.4 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, D47.4 maps to Lymphoma and Other Cancers (HCC 19) with a community, non-dual, aged base RAF weight of 0.105. Under the older CMS-HCC V24 model, D47.4 maps to Severe Hematological Disorders (HCC 46) with a community, non-dual, aged base RAF weight of 0.666. 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.

Distinguish from primary myelofibrosis (PMF) which has its own code; this code is for uncertain behavior classification. Because D47.4 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 D47.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Distinguish from primary myelofibrosis (PMF) which has its own code; this code is for uncertain behavior classification
•Bone marrow biopsy showing fibrosis is typically required for diagnosis confirmation

Clinical Significance

Osteomyelofibrosis is characterized by progressive replacement of bone marrow with fibrous tissue, leading to severe cytopenias and extramedullary hematopoiesis in the spleen and liver. This condition results in debilitating symptoms including fatigue, night sweats, bone pain, and massive splenomegaly, and carries risk of transformation to acute myeloid leukemia.

Documentation Requirements

✓Documentation must include bone marrow biopsy demonstrating fibrosis (reticulin and/or collagen fibrosis grading), peripheral blood counts showing cytopenias or leukoerythroblastic picture, and spleen size.
✓Document constitutional symptoms, transfusion requirements, and JAK2/CALR/MPL mutation status.
✓The Dynamic International Prognostic Scoring System risk score should be calculated and documented.

Excludes 1, Do NOT code together

acute myelofibrosis (C94.4-)

Commonly Confused Codes

•D47.1 (chronic myeloproliferative disease) is a broader category that may include myelofibrosis.
•D75.81 (myelofibrosis) may be used for secondary myelofibrosis.
•D45 (polycythemia vera) or D47.3 (essential thrombocythemia) may evolve into secondary myelofibrosis, which should be coded to this code if the marrow demonstrates fibrosis.
•C94.40 (acute panmyelosis with myelofibrosis) is an acute presentation.