D60.9
BillableAcquired pure red cell aplasia, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D60.9 an HCC code?
Yes. D60.9 maps to Hemolytic and Aplastic Anemias 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 D60.9
For D60.9 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 D60.9 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D60.9 is the ICD-10-CM diagnosis code for acquired pure red cell aplasia, unspecified. A condition where the bone marrow fails to produce red blood cells, but the specific type or cause is not specified. D60.9 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 aplastic and other anemias and other bone marrow failure syndromes (d60-d64).
Under the CMS-HCC V28 risk adjustment model, D60.9 maps to Hemolytic and Aplastic Anemias (HCC 109) with a community, non-dual, aged base RAF weight of 0.291. Under the older CMS-HCC V24 model, D60.9 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.
This is an unspecified code; query the provider to determine if the condition is chronic (D60.0) or transient (D60.1). Because D60.9 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 D60.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Acquired pure red cell aplasia, unspecified is assigned when a patient has documented selective failure of red blood cell production by the bone marrow but the documentation does not specify whether the condition is chronic, transient, or of another defined type. This code represents a documentation gap that should prompt a provider query, as the distinction between chronic and transient forms has significant implications for prognosis, workup (thymoma screening in chronic forms), and treatment approach.
Documentation Requirements
- ✓Document bone marrow findings confirming selective erythroid aplasia.
- ✓Record hemoglobin levels, reticulocyte count, and preserved white blood cell and platelet counts.
- ✓Include what diagnostic workup has been performed to determine the etiology and chronicity.
- ✓Submit a provider query to clarify whether the condition is chronic (D60.0), transient (D60.1), or another specified type (D60.8).
- ✓Document any treatment provided and response.
Commonly Confused Codes
- •D60.0 (Chronic acquired pure red cell aplasia) should be used when chronicity is established.
- •D60.1 (Transient acquired pure red cell aplasia) applies to self-resolving episodes.
- •D61.9 (Aplastic anemia, unspecified) involves failure of all cell lines, not just erythroid.
- •D64.9 (Anemia, unspecified) does not specify the mechanism and is far less informative.