What is ICD-10 code D61.1?

D61.1 is the ICD-10-CM diagnosis code for Drug-induced aplastic anemia. A serious condition where medications or drugs cause the bone marrow to stop producing blood cells. D61.1 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. D61.1 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. D61.1 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. D61.1 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 D61.1 map to under V28?

D61.1 has no payable CMS-HCC V28 mapping in the final FY2026 CMS file.

What RAF reference is published for D61.1?

D61.1 has no V28 reference coefficient because the final FY2026 source verifies no payable V28 mapping.

What is the V28 vs V24 difference for D61.1?

D61.1 has verified no payable V28 mapping in the final FY2026 source. Select a historical effective period before making any V24 comparison.

What documentation supports D61.1?

Document the specific drug or medication causing the aplastic anemia; link the temporal relationship between drug exposure and symptom onset Include the drug name in the medical record and consider using an additional code for the adverse effect if applicable D61.1 is not a CMS-HCC V28 payment code in the verified current source, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

2026 ICD-10-CM D61.1: Drug-induced aplastic anemia

D61.1 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · free HCC coding tools

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 lookupD61.1Effective 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)

D61.1

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

Drug-induced aplastic anemia

A serious condition where medications or drugs cause the bone marrow to stop producing blood cells.

Buddy Insight

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

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

D61.1Drug-induced aplastic anemia

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for D61.1 in this effective period.

Excludes 2

Official

neutropenia (D70.-)

Related Child Codes

Official

D61.0Constitutional aplastic anemia

D61.2Aplastic anemia due to other external agents

D61.3Idiopathic aplastic anemia

D61.8Other specified aplastic anemias and other bone marrow failure syndromes

D61.9Aplastic anemia, unspecified

Includes

Official

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

Excludes 1

Official

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

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for D61.1 in this effective period.

Use Additional

Official

code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

Code Also

Official

ICD-10-CM does not list Code Also instructions for D61.1 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Document the specific causative drug by name with clear temporal relationship between drug exposure and aplastic anemia onset.

Record complete blood count showing pancytopenia and bone marrow biopsy demonstrating hypocellularity.

Include the severity classification (moderate, severe, or very severe aplastic anemia based on absolute neutrophil count, platelet count, and reticulocyte count).

Document treatment with drug discontinuation, immunosuppressive therapy, supportive transfusions, or stem cell transplant.

MEAT Support

HCC Buddy guidance

Document the specific causative drug by name with clear temporal relationship between drug exposure and aplastic anemia onset.

Record complete blood count showing pancytopenia and bone marrow biopsy demonstrating hypocellularity.

Include the severity classification (moderate, severe, or very severe aplastic anemia based on absolute neutrophil count, platelet count, and reticulocyte count).

Document treatment with drug discontinuation, immunosuppressive therapy, supportive transfusions, or stem cell transplant.

Audit Caution

HCC Buddy guidance

Always pair this code with the appropriate external cause code identifying the responsible drug -

the code is incomplete without it. Distinguish drug-induced aplastic anemia (bone marrow failure) from drug-induced isolated cytopenias (neutropenia, thrombocytopenia, or anemia alone). Document the severity using Camitta criteria, as this guides treatment decisions between immunosuppressive therapy and stem cell transplant. The condition may persist after drug discontinuation due to immune-mediated stem cell destruction.

Common Mistakes

HCC Buddy guidance

D61.810 (Antineoplastic chemotherapy induced pancytopenia) is more specific when chemotherapy is the cause.

D61.811 (Other drug-induced pancytopenia) addresses pancytopenia specifically rather than aplastic anemia.

D61.2 (Aplastic anemia due to other external agents) covers non-drug causes like radiation or chemicals.

D61.3 (Idiopathic aplastic anemia) is used when no cause is identified.

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 D61.1 an HCC code?

D61.1 is not in the CMS-HCC V28 or V24 community payment model. D61.1 has a separate mapping under the CMS-HCC ESRD model (HCC 46 (Severe Hematological Disorders)) and the Part D RxHCC model (HCC 96 (Acquired Hemolytic, Aplastic, and Sideroblastic Anemias)); the applicable result needs member context. D61.1 also appears in the HHS-HCC commercial risk model (HCC 068 (HHS-HCC 068 adult, RAF varies by metal level)), which is a commercial market model rather than a Medicare Advantage payment mapping.

Code: D61.1
Description: Drug-induced aplastic anemia
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

HCC Category Mapping

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 D61.1 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for D61.1

For D61.1 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 D61.1 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

D61.1 is the ICD-10-CM diagnosis code for drug-induced aplastic anemia. A serious condition where medications or drugs cause the bone marrow to stop producing blood cells. D61.1 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 aplastic and other anemias and other bone marrow failure syndromes (d60-d64).

D61.1 has no mapping under the CMS-HCC V28 or V24 community payment models. D61.1 has a separate mapping under the CMS-HCC ESRD model (HCC 46 (Severe Hematological Disorders)) and the Part D RxHCC model (HCC 96 (Acquired Hemolytic, Aplastic, and Sideroblastic Anemias)); the applicable result needs member context. D61.1 also appears in the HHS-HCC commercial risk model (HCC 068 (HHS-HCC 068 adult, RAF varies by metal level)), which is a commercial market model rather than a Medicare Advantage payment mapping. Do not assign V28 risk adjustment value from this page; verify the applicable model and payment year before using this code for risk adjustment.

Document the specific drug or medication causing the aplastic anemia; link the temporal relationship between drug exposure and symptom onset.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for D61.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document the specific drug or medication causing the aplastic anemia; link the temporal relationship between drug exposure and symptom onset
•Include the drug name in the medical record and consider using an additional code for the adverse effect if applicable

Clinical Significance

Drug-induced aplastic anemia is a severe and potentially fatal condition where medication exposure triggers destruction or suppression of hematopoietic stem cells, resulting in pancytopenia (low red cells, white cells, and platelets). Unlike drug-induced cytopenias affecting single cell lines, aplastic anemia represents failure of the entire bone marrow. High-risk medications include chloramphenicol, carbamazepine, phenytoin, sulfonamides, gold compounds, and certain chemotherapy agents. The mechanism may involve direct toxicity or idiosyncratic immune-mediated stem cell destruction.

Documentation Requirements

✓Document the specific causative drug by name with clear temporal relationship between drug exposure and aplastic anemia onset.
✓Record complete blood count showing pancytopenia and bone marrow biopsy demonstrating hypocellularity.
✓Include the severity classification (moderate, severe, or very severe aplastic anemia based on absolute neutrophil count, platelet count, and reticulocyte count).
✓Document treatment with drug discontinuation, immunosuppressive therapy, supportive transfusions, or stem cell transplant.
✓Use external cause codes (T36-T50) to identify the responsible drug.

Use Additional Code

code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

Commonly Confused Codes

•D61.810 (Antineoplastic chemotherapy induced pancytopenia) is more specific when chemotherapy is the cause.
•D61.811 (Other drug-induced pancytopenia) addresses pancytopenia specifically rather than aplastic anemia.
•D61.2 (Aplastic anemia due to other external agents) covers non-drug causes like radiation or chemicals.
•D61.3 (Idiopathic aplastic anemia) is used when no cause is identified.
•D61.9 (Aplastic anemia, unspecified) does not identify the drug-induced etiology.