D47.9
BillableNeoplasm of uncertain behavior of lymphoid, hematopoietic and related tissue, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D47.9 an HCC code?
Yes. D47.9 maps to Breast, Prostate, Colorectal and Other Cancers and Tumors 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 D47.9
For D47.9 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 D47.9 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D47.9 is the ICD-10-CM diagnosis code for neoplasm of uncertain behavior of lymphoid, hematopoietic and related tissue, unspecified. This code describes an abnormal growth in blood-forming tissues or lymph tissues that cannot be definitively classified as either cancer or a benign (non-cancerous) condition at the time of diagnosis. It is used when the exact nature of the growth remains uncertain or unspecified. D47.9 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, D47.9 maps to Breast, Prostate, Colorectal and Other Cancers and Tumors (HCC 21) with a community, non-dual, aged base RAF weight of 0.545. Under the older CMS-HCC V24 model, D47.9 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.
Use this code only when the pathology report explicitly states 'uncertain behavior' or when the specific type of lymphoid/hematopoietic neoplasm cannot be determined; avoid using this as a default code if more specific information is available. Because D47.9 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 D47.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the pathology report explicitly states 'uncertain behavior' or when the specific type of lymphoid/hematopoietic neoplasm cannot be determined; avoid using this as a default code if more specific information is available
- •Query the physician or pathology report if a more specific D47.x code (such as D47.1 for chronic myeloproliferative disease or D47.2 for monoclonal neoplasm) can be assigned, as unspecified codes should be used minimally in modern coding practice
Clinical Significance
This unspecified code represents neoplasms of uncertain behavior involving lymphoid, hematopoietic, or related tissues when the specific entity cannot be determined. These conditions involve clonal proliferations with uncertain malignant potential that require specialized hematopathology evaluation for definitive classification and risk stratification.
Documentation Requirements
- ✓Use this code only when documentation confirms a neoplasm of uncertain behavior in lymphoid or hematopoietic tissue but cannot identify the specific subtype.
- ✓Initiate a provider query for bone marrow biopsy findings, flow cytometry results, cytogenetic analysis, and molecular testing.
- ✓Document the clinical presentation and any prior hematologic workup.
Commonly Confused Codes
- •D47.1 (chronic myeloproliferative disease), D47.3 (essential thrombocythemia), and D47.Z1-D47.Z2 are more specific codes within this category.
- •D46.9 (myelodysplastic syndrome, unspecified) covers a different category of bone marrow disorders.
- •C85.90 (non-Hodgkin lymphoma, unspecified) is used for confirmed malignant lymphoid neoplasms.