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.

Which HCC does D47.4 map to under V28?

D47.4 maps to CMS-HCC V28 HCC 19 (Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM D47.4: Osteomyelofibrosis

D47.4 maps to CMS-HCC V28 19. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC Buddy coding tools

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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

Myelodysplastic Syndromes, Mu...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 067

HHS-HCC 067 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 46

Severe Hematological Disorders

Code-level coefficient reference

RXHCC

Mapped

HCC 16

Multiple Myeloma and Other He...

Code-level coefficient reference

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.

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is D47.4 an HCC code?

Yes. D47.4 (Osteomyelofibrosis) maps to HCC 19, Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 1.798. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: D47.4 is billable and maps to V28 HCC 19, Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: D47.4
Description: Osteomyelofibrosis
HCC (V28): HCC 19 — Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers
RAF reference coefficient: 1.798
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 19, Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers

1.798

ESRDHCC 46, Severe Hematological Disorders

Not separately weighted

RxHCCHCC 16, Multiple Myeloma and Other Hematologic Cancers

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work D47.4 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

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.

Coder workflow notes

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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 Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers (HCC 19) with a source-labeled community, non-dual, aged reference coefficient of 1.798. No V24 mapping is shown for D47.4; use the applicable model and payment year when reviewing the V28 mapping. 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. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Distinguish from primary myelofibrosis (PMF) which has its own code; this code is for uncertain behavior classification. Because D47.4 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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, source-labeled coefficient references, 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.