What is ICD-10 code D64.2?

D64.2 is the ICD-10-CM diagnosis code for Secondary sideroblastic anemia due to drugs and toxins. A type of anemia where the bone marrow produces abnormal red blood cells due to exposure to certain medications or toxic substances. D64.2 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. D64.2 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. D64.2 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. D64.2 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 D64.2 map to under V28?

D64.2 has no payable CMS-HCC V28 mapping in the final FY2026 CMS file.

What RAF reference is published for D64.2?

D64.2 has no V28 reference coefficient because the final FY2026 source verifies no payable V28 mapping.

What is the V28 vs V24 difference for D64.2?

D64.2 has verified no payable V28 mapping in the final FY2026 source. Select a historical effective period before making any V24 comparison.

What documentation supports D64.2?

Always identify and document the specific drug or toxin causing the condition Use an additional code to specify the drug or toxin using the Table of Drugs and Chemicals D64.2 is not a CMS-HCC V28 payment code in the verified current source, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

Can D64.2 be a primary diagnosis?

Usually yes, when it is the condition chiefly responsible for the encounter and the note supports it. The exception is in the code-first instruction: when poisoning due to drug or toxin, if applicable (T36-T65 with fifth or sixth character 1-4) is documented, that condition is sequenced first and D64.2 follows it. For risk adjustment the order does not matter; the V28 category is the same either way.

Which codes cannot be reported with D64.2?

The Excludes1 note that applies to D64.2 lists refractory anemia (D46.-); refractory anemia with excess blasts in transformation [RAEB T] (C92.0-). An Excludes1 condition is not reported together with D64.2; report one or the other, unless the two conditions are unrelated, which the ICD-10-CM Official Guidelines (Section I.A.12.a) allow. The Excludes2 note lists autoimmune disease (systemic) NOS (M35.9); certain conditions originating in the perinatal period (P00-P96); complications of pregnancy, childbirth and the puerperium (O00-O9A); congenital malformations, deformations and chromosomal abnormalities (Q00-Q99); and 5 more (see the notes on this page); those are separate conditions that may be reported together with D64.2 when both are documented.

2026 ICD-10-CM D64.2: Secondary sideroblastic anemia due

D64.2 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools

ICD-10-CM Code View

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Code lookupD64.2

Effective 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)

D64.2

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

Secondary sideroblastic anemia due to drugs and toxins

A type of anemia where the bone marrow produces abnormal red blood cells due to exposure to certain medications or toxic substances.

Buddy Insight

Secondary sideroblastic anemia due to drugs and toxins occurs when medications or toxic exposures impair mitochondrial heme synthesis, causing ring sideroblast formation in the bone marrow.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 075

HHS-HCC 075 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 48

Coagulation Defects and Other...

Code-level coefficient reference

RXHCC

Mapped

HCC 96

Acquired Hemolytic, Aplastic,...

Code-level coefficient reference

Code Book Path

Official

D64Other anemias D64.2Secondary sideroblastic anemia due to drugs and toxins

Inclusion Terms

Official

No inclusion terms are included in this display for D64.2. Check the code and parent instructions in the Code Book.

Excludes 2

Official

autoimmune disease (systemic) NOS (M35.9)Inherited from D50-D89
certain conditions originating in the perinatal period (P00-P96)Inherited from D50-D89
complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from D50-D89
congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from D50-D89
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from D50-D89
human immunodeficiency virus [HIV] disease (B20)Inherited from D50-D89
injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from D50-D89
neoplasms (C00-D49)Inherited from D50-D89
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from D50-D89

Related Codes

Official

D64.0Hereditary sideroblastic anemia D64.1Secondary sideroblastic anemia due to disease D64.3Other sideroblastic anemias D64.4Congenital dyserythropoietic anemia D64.8Other specified anemias

Includes

Official

No Includes notes are included in this display for D64.2. Check the code and parent instructions in the Code Book.

Excludes 1

Official

refractory anemia (D46.-)Inherited from D64
refractory anemia with excess blasts in transformation [RAEB T] (C92.0-)Inherited from D64

Code First

Official

poisoning due to drug or toxin, if applicable (T36-T65 with fifth or sixth character 1-4)

Use Additional

Official

code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

Code Also

Official

No Code Also instructions are included in this display for D64.2. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Document the specific causative drug or toxin by name with temporal relationship to anemia onset.

Record bone marrow biopsy findings showing ring sideroblasts.

Include hemoglobin level, mean corpuscular volume, serum iron studies, and pyridoxine level when relevant.

Use external cause codes to identify the responsible agent.

MEAT Support

HCC Buddy guidance

Document the specific causative drug or toxin by name with temporal relationship to anemia onset.

Record bone marrow biopsy findings showing ring sideroblasts.

Include hemoglobin level, mean corpuscular volume, serum iron studies, and pyridoxine level when relevant.

Use external cause codes to identify the responsible agent.

Audit Caution

HCC Buddy guidance

Always pair this code with the appropriate external cause code identifying the responsible drug or toxin. Isoniazid-induced sideroblastic anemia is preventable with concurrent pyridoxine supplementation -

document whether prophylaxis was provided. Chronic alcoholism is a common but underrecognized cause -

ensure documentation connects the alcohol use to the sideroblastic anemia when appropriate. Lead poisoning causing sideroblastic anemia requires specific reporting under public health surveillance. Do not confuse with iron deficiency anemia, which has low iron stores rather than the high iron characteristic of sideroblastic anemias.

Common Mistakes

HCC Buddy guidance

D64.0 (Hereditary sideroblastic anemia) is for inherited genetic forms.

D64.1 (Secondary sideroblastic anemia due to disease) is caused by underlying medical conditions rather than drugs.

D59.2 (Drug-induced nonautoimmune hemolytic anemia) involves red blood cell destruction rather than production defects.

D61.1 (Drug-induced aplastic anemia) affects all cell lines, not just erythropoiesis.

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 D64.2 an HCC code?

D64.2 is not in the CMS-HCC V28 or V24 community payment model. D64.2 has a separate mapping under the CMS-HCC ESRD model (HCC 48 (Coagulation Defects and Other Specified Hematological Disorders)) and the Part D RxHCC model (HCC 96 (Acquired Hemolytic, Aplastic, and Sideroblastic Anemias)); the applicable result needs member context. D64.2 also appears in the HHS-HCC commercial risk model (HCC 075 (HHS-HCC 075 adult, RAF varies by metal level)), which is a commercial market model rather than a Medicare Advantage payment mapping.

Code: D64.2
Description: Secondary sideroblastic anemia due to drugs and toxins
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

HCC Category Mapping

ESRDHCC 48, Coagulation Defects and Other Specified Hematological Disorders

Not separately weighted

RxHCCHCC 96, Acquired Hemolytic, Aplastic, and Sideroblastic Anemias

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work D64.2 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for D64.2

For D64.2, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

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

Coder workflow notes

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What This Code Means

D64.2 is the ICD-10-CM diagnosis code for secondary sideroblastic anemia due to drugs and toxins. A type of anemia where the bone marrow produces abnormal red blood cells due to exposure to certain medications or toxic substances. D64.2 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).

D64.2 has no mapping under the CMS-HCC V28 or V24 community payment models. D64.2 has a separate mapping under the CMS-HCC ESRD model (HCC 48 (Coagulation Defects and Other Specified Hematological Disorders)) and the Part D RxHCC model (HCC 96 (Acquired Hemolytic, Aplastic, and Sideroblastic Anemias)); the applicable result needs member context. D64.2 also appears in the HHS-HCC commercial risk model (HCC 075 (HHS-HCC 075 adult, RAF varies by metal level)), which is a commercial market model rather than a Medicare Advantage payment mapping. Do not assign V28 risk adjustment value from this page; verify the applicable model and payment year before using this code for risk adjustment.

Always identify and document the specific drug or toxin causing the condition.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for D64.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Always identify and document the specific drug or toxin causing the condition
•Use an additional code to specify the drug or toxin using the Table of Drugs and Chemicals

Clinical Significance

Secondary sideroblastic anemia due to drugs and toxins occurs when medications or toxic exposures impair mitochondrial heme synthesis, causing ring sideroblast formation in the bone marrow. The most common causative agents include isoniazid (which depletes pyridoxine, a cofactor in heme synthesis), chloramphenicol, cycloserine, linezolid, lead exposure, ethanol (chronic alcoholism is a leading cause), and zinc excess. The condition is typically reversible upon discontinuation of the offending agent and supplementation with pyridoxine when appropriate.

Documentation Requirements

✓Document the specific causative drug or toxin by name with temporal relationship to anemia onset.
✓Record bone marrow biopsy findings showing ring sideroblasts.
✓Include hemoglobin level, mean corpuscular volume, serum iron studies, and pyridoxine level when relevant.
✓Use external cause codes to identify the responsible agent.
✓Document whether the offending agent has been discontinued and whether pyridoxine supplementation has been initiated.
✓Record response to treatment and hemoglobin recovery timeline.

Use Additional Code

code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

Code First

poisoning due to drug or toxin, if applicable (T36-T65 with fifth or sixth character 1-4)

Commonly Confused Codes

•D64.0 (Hereditary sideroblastic anemia) is for inherited genetic forms.
•D64.1 (Secondary sideroblastic anemia due to disease) is caused by underlying medical conditions rather than drugs.
•D59.2 (Drug-induced nonautoimmune hemolytic anemia) involves red blood cell destruction rather than production defects.
•D61.1 (Drug-induced aplastic anemia) affects all cell lines, not just erythropoiesis.
•D64.3 (Other sideroblastic anemias) is a less specific alternative.