D47.4
BillableOsteomyelofibrosis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
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
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 D47.4 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 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-)