D61.89
BillableOther specified aplastic anemias and other bone marrow failure syndromes
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D61.89 an HCC code?
Yes. D61.89 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 D61.89
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.
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 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, D61.89 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.
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.