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.

What is the V28 vs V24 difference for D61.09?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For D61.09, V28 maps to Hemolytic and Aplastic Anemias at RAF 0.291 while V24 mapped to Severe Hematological Disorders at RAF 0.666. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting 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 a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

D61.09 ICD-10 Code: Other constitutional aplastic

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

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

Hemolytic and Aplastic Anemias

RAF 0.291

CMS-HCC V24

Mapped

HCC 46

Severe Hematological Disorders

RAF 0.666

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Mapped

HCC 46

Severe Hematological Disorders

RAF 0.0

RXHCC

Mapped

HCC 96

Hemolytic and Aplastic Anemias

RAF 0.0

Code Trumping

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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.

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 D61.09 an HCC code?

Yes. D61.09 maps to Hemolytic and Aplastic Anemias under the CMS-HCC V28 risk adjustment model (and Severe Hematological Disorders under V24).

HCC Category Mapping

V28HCC 109 — Hemolytic and Aplastic Anemias

0.291

V24HCC 46 — Severe Hematological Disorders

0.666

ESRDHCC 46 — Severe Hematological Disorders

0.000

RxHCCHCC 96 — Hemolytic and Aplastic Anemias

0.000

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 D61.09

For D61.09to 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.

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 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, D61.09 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.

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 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 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.