D61.818
BillableOther pancytopenia
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D61.818 an HCC code?
Yes. D61.818 maps to Hemolytic and Aplastic Anemias under the CMS-HCC V28 risk adjustment model (and Disorders of Immunity under V24).
HCC Category Mapping
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 D61.818
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.
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 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, D61.818 maps to Disorders of Immunity (HCC 47) with a community, non-dual, aged base RAF weight of 0.472. 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.