What is ICD-10 code D61.89?

D61.89 is the ICD-10-CM diagnosis code for Other specified aplastic anemias and other bone marrow failure syndromes. Rare bone marrow failure conditions that don't fit into other specific categories, resulting in the inability to produce adequate blood cells. D61.89 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. D61.89 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. D61.89 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. D61.89 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 D61.89 map to under V28?

D61.89 maps to CMS-HCC V28 109 (Acquired Hemolytic, Aplastic, and Sideroblastic Anemias). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does D61.89 pay in RAF?

D61.89 carries a community, non-dual, aged (CNA) RAF weight of 1.144 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for D61.89?

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 D61.89, V28 maps to Acquired Hemolytic, Aplastic, and Sideroblastic Anemias at RAF 1.144 while V24 mapped to Severe Hematological Disorders at RAF 1.372. Both models can still appear in legacy data and in payer-specific lookback periods.

2026 ICD-10-CM D61.89: Other specified

D61.89 maps to CMS-HCC V28 109 (RAF 1.144). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC Buddy 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 lookupD61.89Effective 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)

D61.89

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

Other specified aplastic anemias and other bone marrow failure syndromes

Rare bone marrow failure conditions that don't fit into other specific categories, resulting in the inability to produce adequate blood cells.

Buddy Insight

CMS-HCC V28

Mapped

HCC 109

Acquired Hemolytic, Aplastic,...

RAF 1.144

CMS-HCC V24

Mapped

HCC 46

Severe Hematological Disorders

RAF 1.372

ACA/HHS

Mapped

HCC 68

HHS-HCC 68

Varies by metal level

ESRD/PACE

Mapped

HCC 46

Severe Hematological Disorders

RAF 0.223

RXHCC

Mapped

HCC 96

Hemolytic and Aplastic Anemias

RAF 0.722

Code Book Path

Official

D61Other aplastic anemias and other bone marrow failure syndromes

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

D61.89Other specified aplastic anemias and other bone marrow failure syndromes

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for D61.89 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for D61.89 in this effective period.

Related Child Codes

Official

D61.81Pancytopenia

D61.82Myelophthisis

Includes

Official

ICD-10-CM does not list Includes notes for D61.89 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for D61.89 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for D61.89 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for D61.89 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for D61.89 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Document the specific aplastic anemia or bone marrow failure syndrome by name.

Record complete blood count values showing cytopenias and bone marrow biopsy findings demonstrating hypocellularity.

Include the identified etiology or clinical context that distinguishes this condition from other aplastic anemia categories.

Document treatment approach (immunosuppressive therapy, stem cell transplant, supportive care) and response.

MEAT Support

HCC Buddy guidance

Document the specific aplastic anemia or bone marrow failure syndrome by name.

Record complete blood count values showing cytopenias and bone marrow biopsy findings demonstrating hypocellularity.

Include the identified etiology or clinical context that distinguishes this condition from other aplastic anemia categories.

Document treatment approach (immunosuppressive therapy, stem cell transplant, supportive care) and response.

Audit Caution

HCC Buddy guidance

Use this code only when the condition does not fit any of the more specific aplastic anemia codes (D60.x, D61.0x, D61.1-D61.3, D61.81x, D61.82). Document the specific condition in the medical record even though ICD-10 lacks a unique code for it -

this supports audit defensibility. Code any underlying or associated conditions separately. The 'other specified' designation is always preferable to 'unspecified' when clinical detail is available.

Common Mistakes

HCC Buddy guidance

D61.1 (Drug-induced aplastic anemia) is for medication-related causes.

D61.2 (Aplastic anemia due to other external agents) covers environmental exposures.

D61.3 (Idiopathic aplastic anemia) is for cases with no identifiable cause.

D61.82 (Myelophthisis) specifically involves bone marrow infiltration.

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 D61.89 an HCC code?

Yes. D61.89 (Other specified aplastic anemias and other bone marrow failure syndromes) maps to Acquired Hemolytic, Aplastic, and Sideroblastic Anemias under the CMS-HCC V28 risk adjustment model (and Severe Hematological Disorders under V24), with a community non-dual aged RAF of 1.144. It is billable for payment year 2026.

Coder answer: D61.89 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: D61.89
Description: Other specified aplastic anemias and other bone marrow failure syndromes
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 46, Severe Hematological Disorders

1.372

ESRDHCC 46, Severe Hematological Disorders

0.223

RxHCCHCC 96, Hemolytic and Aplastic Anemias

0.722

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 D61.89 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for D61.89

For D61.89 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 D61.89 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

D61.89 is the ICD-10-CM diagnosis code for other specified aplastic anemias and other bone marrow failure syndromes. Rare bone marrow failure conditions that don't fit into other specific categories, resulting in the inability to produce adequate blood cells. D61.89 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, D61.89 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, D61.89 maps to Severe Hematological Disorders (HCC 46) with a community, non-dual, aged base RAF weight of 1.372. 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 when a more specific aplastic anemia or bone marrow failure code is not applicable. Because D61.89 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 D61.89 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use this code only when a more specific aplastic anemia or bone marrow failure code is not applicable
•Document the specific condition in the medical record to support code selection

Clinical Significance

Other specified aplastic anemias and other bone marrow failure syndromes encompasses conditions where the bone marrow fails to adequately produce blood cells through mechanisms not captured by more specific aplastic anemia codes. This includes conditions such as bone marrow failure associated with pregnancy, aplastic anemia following viral hepatitis (non-drug related), and other specified acquired aplastic states. The designation 'other specified' indicates the clinician has identified a specific condition even though ICD-10 does not provide a unique code for it.

Documentation Requirements

✓Document the specific aplastic anemia or bone marrow failure syndrome by name.
✓Record complete blood count values showing cytopenias and bone marrow biopsy findings demonstrating hypocellularity.
✓Include the identified etiology or clinical context that distinguishes this condition from other aplastic anemia categories.
✓Document treatment approach (immunosuppressive therapy, stem cell transplant, supportive care) and response.
✓Note disease severity using standard classification criteria.

Commonly Confused Codes

•D61.1 (Drug-induced aplastic anemia) is for medication-related causes.
•D61.2 (Aplastic anemia due to other external agents) covers environmental exposures.
•D61.3 (Idiopathic aplastic anemia) is for cases with no identifiable cause.
•D61.82 (Myelophthisis) specifically involves bone marrow infiltration.
•D61.9 (Aplastic anemia, unspecified) is less specific and should not be used when a specific condition is documented.