D47.Z1
BillablePost-transplant lymphoproliferative disorder (PTLD)
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D47.Z1 an HCC code?
Yes. D47.Z1 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.Z1
For D47.Z1 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.Z1 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D47.Z1 is the ICD-10-CM diagnosis code for post-transplant lymphoproliferative disorder (ptld). An abnormal growth of lymphoid cells that develops after an organ or tissue transplant due to weakened immune function. D47.Z1 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.Z1 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.Z1 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.
Always link this diagnosis to a transplant procedure; document the type of transplant (bone marrow, solid organ, etc.). Because D47.Z1 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.Z1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Always link this diagnosis to a transplant procedure; document the type of transplant (bone marrow, solid organ, etc.)
- •Include the timeframe of PTLD development relative to transplant date in clinical documentation
Clinical Significance
Post-transplant lymphoproliferative disorder is a potentially life-threatening complication of solid organ or hematopoietic stem cell transplantation, resulting from uncontrolled lymphoid proliferation due to immunosuppression. The spectrum ranges from benign polyclonal hyperplasia to aggressive monoclonal lymphoma, and it is frequently associated with Epstein-Barr virus reactivation in the immunosuppressed host.
Documentation Requirements
- ✓Documentation must link the lymphoproliferative disorder to a prior transplant, specifying the type of transplant (kidney, liver, heart, lung, bone marrow) and timing of onset relative to transplantation.
- ✓Tissue biopsy confirming lymphoid proliferation is required.
- ✓Epstein-Barr virus status (viral load, in situ hybridization), immunosuppression regimen, and pathologic subtype (early lesion, polymorphic, monomorphic) should be documented.
Code First
- complications of transplanted organs and tissue (T86.-)
Commonly Confused Codes
- •C83-C85 (non-Hodgkin lymphoma codes) may be used for monomorphic post-transplant lymphoproliferative disorder that meets criteria for a specific lymphoma subtype.
- •D47.9 (uncertain behavior of lymphoid/hematopoietic tissue, unspecified) is less specific.
- •T86.x codes should be used additionally to identify the type of transplant and any graft complications.