D61.03 ICD-10-CM Code: Fanconi anemia
D61.03 maps to CMS-HCC V28 109. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89) / Aplastic and other anemias and other bone marrow failure syndromes (D60-D64)
D61.03
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceFanconi anemia
Fanconi anemia is a rare inherited blood disorder that affects the bone marrow's ability to produce blood cells, leading to low counts of red blood cells, white blood cells, and platelets. Patients with this condition have an increased risk of developing certain cancers and may experience fatigue, infections, and bleeding problems.
Buddy Insight
Fanconi anemia is a rare autosomal recessive (or rarely X-linked) inherited bone marrow failure syndrome caused by mutations in DNA repair pathway genes, characterized by progressive pancytopenia, congenital anomalies, and a markedly elevated risk of malignancies.
CMS-HCC V28
MappedHCC 109
Coefficient HCC 109: 1.144 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 068
Code-level coefficient reference
ESRD/PACE
MappedHCC 46
Code-level coefficient reference
RXHCC
MappedHCC 96
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- Fanconi pancytopenia
- Fanconi's anemia
Excludes 2
Official- autoimmune disease (systemic) NOS (M35.9)Inherited from D50-D89, D61
- certain conditions originating in the perinatal period (P00-P96)Inherited from D50-D89, D61
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from D50-D89, D61
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from D50-D89, D61
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from D50-D89, D61
- human immunodeficiency virus [HIV] disease (B20)Inherited from D50-D89, D61
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from D50-D89, D61
- neoplasms (C00-D49)Inherited from D50-D89, D61
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from D50-D89, D61
- neutropenia (D70.-)Inherited from D50-D89, D61
Related Codes
Includes
OfficialNo Includes notes are included in this display for D61.03. Check the code and parent instructions in the Code Book.
Excludes 1
Official- Fanconi syndrome (E72.0-)
Code First
OfficialNo Code First sequencing instructions are included in this display for D61.03. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for D61.03. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for D61.03. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 D61.03 an HCC code?
Yes. D61.03 (Fanconi anemia) maps to HCC 109, Acquired Hemolytic, Aplastic, and Sideroblastic Anemias under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 1.144. 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: D61.03 is billable and maps to V28 HCC 109, Acquired Hemolytic, Aplastic, and Sideroblastic Anemias. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- D61.03
- Description
- Fanconi anemia
- HCC (V28)
- HCC 109 — Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
- RAF reference coefficient
- 1.144
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 D61.03 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for D61.03
For D61.03, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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What This Code Means
D61.03 is the ICD-10-CM diagnosis code for fanconi anemia. Fanconi anemia is a rare inherited blood disorder that affects the bone marrow's ability to produce blood cells, leading to low counts of red blood cells, white blood cells, and platelets. Patients with this condition have an increased risk of developing certain cancers and may experience fatigue, infections, and bleeding problems. D61.03 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, D61.03 maps to Acquired Hemolytic, Aplastic, and Sideroblastic Anemias (HCC 109) with a source-labeled community, non-dual, aged reference coefficient of 1.144. No V24 mapping is shown for D61.03; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. 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.
Fanconi anemia is a genetic disorder; verify documentation specifies the type or subtype if available, as there are multiple complementation groups (A through Q). For D61.03, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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 D61.03 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Fanconi anemia is a genetic disorder; verify documentation specifies the type or subtype if available, as there are multiple complementation groups (A through Q)
- •When coding Fanconi anemia, look for associated complications such as cytopenias, infections, or malignancies that should be coded separately to capture the full clinical picture
Clinical Significance
Fanconi anemia is a rare autosomal recessive (or rarely X-linked) inherited bone marrow failure syndrome caused by mutations in DNA repair pathway genes, characterized by progressive pancytopenia, congenital anomalies, and a markedly elevated risk of malignancies. Physical findings may include short stature, cafe-au-lait spots, thumb and radial ray abnormalities, renal malformations, and microcephaly, though up to 30% of patients have no visible anomalies. The median age of bone marrow failure onset is 7 years, with lifetime risks of approximately 50% for acute myeloid leukemia and 25% for head and neck squamous cell carcinomas.
Documentation Requirements
- ✓Document chromosomal breakage analysis (mitomycin C or diepoxybutane testing) confirming Fanconi anemia diagnosis.
- ✓Record the specific complementation group (FANCA through FANCQ) when genetic testing has been performed.
- ✓Include complete blood count trends showing progressive cytopenias, bone marrow biopsy findings, and any congenital anomalies documented on physical examination or imaging.
- ✓Document treatment including androgen therapy, hematopoietic growth factors, transfusion history, and stem cell transplant status.
- ✓Note any malignancy surveillance performed.
Excludes 1, Do NOT code together
- Fanconi syndrome (E72.0-)
Commonly Confused Codes
- •D61.01 (Constitutional pure red blood cell aplasia) affects only red cells, not all lineages.
- •D61.02 (Shwachman-Diamond syndrome) involves pancreatic insufficiency without DNA repair defects.
- •D61.09 (Other constitutional aplastic anemia) is less specific and should not be used when Fanconi anemia is confirmed.
- •D46.x (Myelodysplastic syndromes) may develop as a complication but is a separate diagnosis requiring additional coding.