D61.82
BillableMyelophthisis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D61.82 an HCC code?
Yes. D61.82 maps to Hemolytic and Aplastic Anemias under the CMS-HCC V28 risk adjustment model (and Severe Hematological Disorders 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 D61.82
For D61.82 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 D61.82 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D61.82 is the ICD-10-CM diagnosis code for myelophthisis. A condition where the bone marrow is replaced or infiltrated by abnormal tissue, preventing it from producing normal blood cells. D61.82 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, D61.82 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, D61.82 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.
Link to the underlying condition causing bone marrow infiltration (malignancy, fibrosis, etc.). Because D61.82 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 D61.82 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Link to the underlying condition causing bone marrow infiltration (malignancy, fibrosis, etc.)
- •Document the type of infiltrating process when documented in the medical record
Clinical Significance
Myelophthisis describes bone marrow failure caused by replacement of normal hematopoietic tissue by abnormal cells or fibrous tissue, disrupting normal blood cell production. The most common cause is metastatic cancer infiltrating the bone marrow (especially breast, prostate, lung, and neuroblastoma), but other causes include myelofibrosis, storage diseases (Gaucher disease), and granulomatous infections. A characteristic leukoerythroblastic blood picture with immature white blood cells and nucleated red blood cells in the peripheral blood results from the displaced hematopoietic cells being prematurely released.
Documentation Requirements
- ✓Document the underlying condition causing bone marrow infiltration (specific malignancy, fibrosis, storage disease, or granulomatous process).
- ✓Record bone marrow biopsy findings showing replacement of normal hematopoietic tissue by abnormal cells or fibrosis.
- ✓Include complete blood count values and peripheral blood smear findings (leukoerythroblastic picture, teardrop cells).
- ✓Document the primary condition as the underlying cause and code it separately.
- ✓Note any treatment directed at the infiltrating process.
Excludes 1 — Do NOT code together
Commonly Confused Codes
- •D61.89 (Other specified aplastic anemias and bone marrow failure syndromes) is for non-infiltrative bone marrow failure.
- •D47.1 (Chronic myeloproliferative disease, unspecified) or D75.81 (Myelofibrosis) may be the underlying cause.
- •D61.9 (Aplastic anemia, unspecified) implies a different mechanism of marrow failure.
- •C79.52 (Secondary malignant neoplasm of bone marrow) should be coded when metastatic cancer is the cause of myelophthisis.