D53.1 ICD-10-CM Code: Other megaloblastic anemias, not elsewhere classified
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89) / Nutritional anemias (D50-D53)
D53.1
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther megaloblastic anemias, not elsewhere classified
A rare type of anemia characterized by abnormally large red blood cells caused by nutritional deficiencies other than B12 or folate.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Megaloblastic anemia NOS
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for D53.1 in this effective period.
Related Child Codes
Includes
Official- megaloblastic anemia unresponsive to vitamin B12 or folate therapy
Excludes 1
Official- Di Guglielmo's disease (C94.0)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for D53.1 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for D53.1 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for D53.1 in this effective period.
Buddy Documentation Tip
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 D53.1 an HCC code?
No. D53.1 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- D53.1
- Description
- Other megaloblastic anemias, not elsewhere classified
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
D53.1 is the ICD-10-CM diagnosis code for other megaloblastic anemias, not elsewhere classified. A rare type of anemia characterized by abnormally large red blood cells caused by nutritional deficiencies other than B12 or folate. D53.1 sits in the ICD-10-CM chapter for diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (d50-d89), within the section covering nutritional anemias (d50-d53).
D53.1 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Verify that B12 and folate deficiencies have been ruled out before assigning this code.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for D53.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify that B12 and folate deficiencies have been ruled out before assigning this code
- •Document the specific nutritional cause if identifiable
Excludes 1, Do NOT code together
- Di Guglielmo's disease (C94.0)