What is ICD-10 code D61.09?

D61.09 is the ICD-10-CM diagnosis code for Other constitutional aplastic anemia. It belongs to the ICD-10-CM chapter for diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (d50-d89). D61.09 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. D61.09 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. D61.09 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. D61.09 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does D61.09 map to under V28?

D61.09 maps to CMS-HCC V28 HCC 109 (Acquired Hemolytic, Aplastic, and Sideroblastic Anemias). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

What documentation supports D61.09?

Verify the specific type of constitutional aplastic anemia in the medical record, as code D61.09 is used only when the condition doesn't fit more specific subtypes like Fanconi anemia (D61.09 excludes D61.01) Document whether the condition is congenital or acquired, and look for any associated conditions or complications that may require additional codes Because D61.09 maps to an HCC category, the documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. MEAT is generic documentation evidence, not a payer-specific rule.

2026 ICD-10-CM D61.09: Other constitutional

D61.09 maps to CMS-HCC V28 109. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC coding software

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Code lookupD61.09Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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)

D61.09

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Other constitutional aplastic anemia

This is a rare blood disorder where the bone marrow fails to produce enough blood cells (red blood cells, white blood cells, and platelets) due to an inherited or constitutional condition that is not otherwise specified. Patients with this condition are at risk for infections, bleeding, and severe anemia.

Buddy Insight

Other constitutional aplastic anemia captures rare inherited bone marrow failure syndromes not classified under Diamond-Blackfan anemia, Shwachman-Diamond syndrome, or Fanconi anemia.

CMS-HCC V28

Mapped

HCC 109

Acquired Hemolytic, Aplastic,...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 068

HHS-HCC 068 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 46

Severe Hematological Disorders

Code-level coefficient reference

RXHCC

Mapped

HCC 96

Acquired Hemolytic, Aplastic,...

Code-level coefficient reference

Code Book Path

Official

D61Other aplastic anemias and other bone marrow failure syndromes

D61.0Constitutional aplastic anemia

D61.09Other constitutional aplastic anemia

Inclusion Terms

Official

Pancytopenia with malformations

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for D61.09 in this effective period.

Related Child Codes

Official

D61.01Constitutional (pure) red blood cell aplasia

D61.02Shwachman-Diamond syndrome

D61.03Fanconi anemia

Includes

Official

ICD-10-CM does not list Includes notes for D61.09 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for D61.09 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for D61.09 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for D61.09 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for D61.09 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Document the specific constitutional aplastic anemia syndrome by name when identified.

Include genetic testing results confirming the inherited nature.

Record complete blood count values, bone marrow biopsy findings, and any characteristic physical features associated with the specific syndrome.

Document family history of bone marrow failure or related conditions.

MEAT Support

HCC Buddy guidance

Document the specific constitutional aplastic anemia syndrome by name when identified.

Include genetic testing results confirming the inherited nature.

Record complete blood count values, bone marrow biopsy findings, and any characteristic physical features associated with the specific syndrome.

Document family history of bone marrow failure or related conditions.

Audit Caution

HCC Buddy guidance

Ensure the condition is truly constitutional (inherited/congenital) and not acquired aplastic anemia before using this code. Genetic testing advances may identify specific syndromes that warrant more precise coding -

review updated coding guidelines periodically. Code the specific named syndrome in the medical record even when ICD-10 does not have a unique code for it. Associated manifestations and complications should be coded separately to capture the full clinical picture.

Common Mistakes

HCC Buddy guidance

D61.01 (Constitutional pure red blood cell aplasia) is specific to Diamond-Blackfan anemia.

D61.02 (Shwachman-Diamond syndrome) and D61.03 (Fanconi anemia) have their own specific codes.

D61.9 (Aplastic anemia, unspecified) does not specify the constitutional nature.

D61.89 (Other specified aplastic anemias) is for acquired, not constitutional, aplastic conditions.

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 D61.09 an HCC code?

Yes. D61.09 (Other constitutional aplastic 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: D61.09 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: D61.09
Description: Other constitutional aplastic anemia
HCC (V28): HCC 109 — Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
RAF reference coefficient: 1.144
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 109, Acquired Hemolytic, Aplastic, and Sideroblastic Anemias

1.144

ESRDHCC 46, Severe Hematological Disorders

Not separately weighted

RxHCCHCC 96, Acquired Hemolytic, Aplastic, and Sideroblastic Anemias

Not separately weighted

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 D61.09 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for D61.09

For D61.09 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 D61.09 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

D61.09 is the ICD-10-CM diagnosis code for other constitutional aplastic anemia. This is a rare blood disorder where the bone marrow fails to produce enough blood cells (red blood cells, white blood cells, and platelets) due to an inherited or constitutional condition that is not otherwise specified. Patients with this condition are at risk for infections, bleeding, and severe anemia. D61.09 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, D61.09 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 D61.09; use the applicable model and payment year when reviewing the V28 mapping. 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. 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.

Verify the specific type of constitutional aplastic anemia in the medical record, as code D61.09 is used only when the condition doesn't fit more specific subtypes like Fanconi anemia (D61.09 excludes D61.01). Because D61.09 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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 D61.09 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Verify the specific type of constitutional aplastic anemia in the medical record, as code D61.09 is used only when the condition doesn't fit more specific subtypes like Fanconi anemia (D61.09 excludes D61.01)
•Document whether the condition is congenital or acquired, and look for any associated conditions or complications that may require additional codes

Clinical Significance

Other constitutional aplastic anemia captures rare inherited bone marrow failure syndromes not classified under Diamond-Blackfan anemia, Shwachman-Diamond syndrome, or Fanconi anemia. This includes conditions such as dyskeratosis congenita (telomere biology disorders), congenital amegakaryocytic thrombocytopenia that progresses to aplasia, and other genetic bone marrow failure syndromes identified through advances in genetic testing. These rare conditions share the features of inherited bone marrow failure with varying patterns of cytopenia and associated clinical manifestations.

Documentation Requirements

✓Document the specific constitutional aplastic anemia syndrome by name when identified.
✓Include genetic testing results confirming the inherited nature.
✓Record complete blood count values, bone marrow biopsy findings, and any characteristic physical features associated with the specific syndrome.
✓Document family history of bone marrow failure or related conditions.
✓Note treatment approach including supportive care, stem cell transplant considerations, and any malignancy surveillance.

Commonly Confused Codes

•D61.01 (Constitutional pure red blood cell aplasia) is specific to Diamond-Blackfan anemia.
•D61.02 (Shwachman-Diamond syndrome) and D61.03 (Fanconi anemia) have their own specific codes.
•D61.9 (Aplastic anemia, unspecified) does not specify the constitutional nature.
•D61.89 (Other specified aplastic anemias) is for acquired, not constitutional, aplastic conditions.