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D61.818 ICD-10-CM Code: Other pancytopenia

D61.818 maps to CMS-HCC V28 109 (RAF 1.144). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC Buddy coding tools

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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)

D61.818

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

Other pancytopenia

A reduction in all types of blood cells (red cells, white cells, and platelets) due to causes other than chemotherapy or specified conditions.

Buddy the Bee presenting code insight

Buddy Insight

Other pancytopenia captures the dangerous reduction of all three blood cell lines from causes other than chemotherapy or other identified drugs, including pancytopenia from viral infections (human immunodeficiency virus, hepatitis, Epstein-Barr virus), nutritional deficiencies (severe folate or vitamin B12 deficiency), hypersplenism, bone marrow infiltration by non-malignant processes, and autoimmune conditions such as systemic lupus erythematosus.

CMS-HCC V28

HCC 109

RAF 1.144

CMS-HCC V24

HCC 47

RAF 0.665

ACA/HHS

N/A

—

Not mapped

ESRD/PACE

HCC 47

RAF 0.078

RXHCC

N/A

—

Not mapped

Code Book Path

Official
D61.8Other specified aplastic anemias and other bone marrow failure syndromes
D61.81Pancytopenia
D61.818Other pancytopenia

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for D61.818 in this effective period.

Excludes 2

Official
  • pancytopenia (due to) (with) myelodysplastic syndromes (D46.-)

Related Child Codes

Official
D61.810Antineoplastic chemotherapy induced pancytopenia
D61.811Other drug-induced pancytopenia

Includes

Official

ICD-10-CM does not list Includes notes for D61.818 in this effective period.

Excludes 1

Official
  • pancytopenia (due to) (with) aplastic anemia (D61.9)
  • pancytopenia (due to) (with) bone marrow infiltration (D61.82)
  • pancytopenia (due to) (with) congenital (pure) red cell aplasia (D61.01)
  • pancytopenia (due to) (with) hairy cell leukemia (C91.4-)
  • pancytopenia (due to) (with) human immunodeficiency virus disease (B20.-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for D61.818 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for D61.818 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for D61.818 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Document the underlying cause of pancytopenia when identified.
Record all three cytopenia values: hemoglobin, absolute neutrophil count, and platelet count.
Include bone marrow biopsy results if performed.
Document the diagnostic workup performed to identify the cause, including viral serologies, nutritional studies, autoimmune markers, and imaging for splenomegaly or infiltrative processes.

MEAT Support

HCC Buddy guidance
Document the underlying cause of pancytopenia when identified.
Record all three cytopenia values: hemoglobin, absolute neutrophil count, and platelet count.
Include bone marrow biopsy results if performed.
Document the diagnostic workup performed to identify the cause, including viral serologies, nutritional studies, autoimmune markers, and imaging for splenomegaly or infiltrative processes.

Audit Caution

HCC Buddy guidance
Distinguish pancytopenia (a laboratory finding of low counts in all three lines) from aplastic anemia (a specific bone marrow failure diagnosis) -
they are not synonymous. Always code the underlying cause separately when identified. When severe vitamin B12 or folate deficiency causes pancytopenia, the nutritional deficiency is the primary diagnosis. Hypersplenism causing pancytopenia should be coded with the spleen condition as primary. Do not use this code when a more specific pancytopenia code applies.

Common Mistakes

HCC Buddy guidance
D61.810 (Antineoplastic chemotherapy induced pancytopenia) and D61.811 (Other drug-induced pancytopenia) are drug-related.
D61.9 (Aplastic anemia, unspecified) implies bone marrow failure specifically, while pancytopenia may have peripheral causes (hypersplenism).
D61.82 (Myelophthisis) is specifically for bone marrow replacement by abnormal tissue.
D46.x (Myelodysplastic syndromes) should be considered when dysplastic changes are present on bone marrow biopsy.

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 D61.818 an HCC code?

Yes. D61.818 (Other pancytopenia) maps to Acquired Hemolytic, Aplastic, and Sideroblastic Anemias under the CMS-HCC V28 risk adjustment model (and Disorders of Immunity under V24), with a community non-dual aged RAF of 1.144. It is billable for payment year 2026.

Coder answer: D61.818 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
D61.818
Description
Other pancytopenia
HCC (V28)
HCC 109 — Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
RAF
1.144
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 109, Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
1.144
V24HCC 47, Disorders of Immunity
0.665
ESRDHCC 47, Disorders of Immunity
0.078

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work D61.818 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for D61.818

For D61.818 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 D61.818 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

D61.818 is the ICD-10-CM diagnosis code for other pancytopenia. A reduction in all types of blood cells (red cells, white cells, and platelets) due to causes other than chemotherapy or specified conditions. D61.818 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, D61.818 maps to Acquired Hemolytic, Aplastic, and Sideroblastic Anemias (HCC 109) with a community, non-dual, aged base RAF weight of 1.144. Under the older CMS-HCC V24 model, D61.818 maps to Disorders of Immunity (HCC 47) with a community, non-dual, aged base RAF weight of 0.665. 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.

Use this code only after excluding chemotherapy-induced and other specified causes. Because D61.818 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 D61.818 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Use this code only after excluding chemotherapy-induced and other specified causes
  • •Investigate and document the underlying etiology when possible for better clinical clarity

Clinical Significance

Other pancytopenia captures the dangerous reduction of all three blood cell lines from causes other than chemotherapy or other identified drugs, including pancytopenia from viral infections (human immunodeficiency virus, hepatitis, Epstein-Barr virus), nutritional deficiencies (severe folate or vitamin B12 deficiency), hypersplenism, bone marrow infiltration by non-malignant processes, and autoimmune conditions such as systemic lupus erythematosus. Identifying the underlying cause is essential because treatment is directed at the root etiology rather than simply supporting blood counts.

Documentation Requirements

  • ✓Document the underlying cause of pancytopenia when identified.
  • ✓Record all three cytopenia values: hemoglobin, absolute neutrophil count, and platelet count.
  • ✓Include bone marrow biopsy results if performed.
  • ✓Document the diagnostic workup performed to identify the cause, including viral serologies, nutritional studies, autoimmune markers, and imaging for splenomegaly or infiltrative processes.
  • ✓Record treatment directed at the underlying cause and any supportive measures.

Commonly Confused Codes

  • •D61.810 (Antineoplastic chemotherapy induced pancytopenia) and D61.811 (Other drug-induced pancytopenia) are drug-related.
  • •D61.9 (Aplastic anemia, unspecified) implies bone marrow failure specifically, while pancytopenia may have peripheral causes (hypersplenism).
  • •D61.82 (Myelophthisis) is specifically for bone marrow replacement by abnormal tissue.
  • •D46.x (Myelodysplastic syndromes) should be considered when dysplastic changes are present on bone marrow biopsy.

Child Codes

D61.810Antineoplastic chemotherapy induced pancytopenia
D61.811Other drug-induced pancytopenia
D61.818Other pancytopenia
HCC 109

Code Hierarchy

└D61Other aplastic anemias and other bone marrow failure syndromes└D61.8Other specified aplastic anemias and other bone marrow failure syndromes└D61.81Pancytopenia└D61.818Other pancytopenia
└D61.818Other pancytopenia

Because D61.818 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.

D61.818 maps to CMS-HCC V28 category 109, Acquired Hemolytic, Aplastic, and Sideroblastic Anemias. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. Because D61.818 carries a payment HCC, you can see what it adds to a RAF score and check the documentation the chart needs before it is submitted.

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