D64.3 ICD-10-CM Code: Other sideroblastic anemias
D64.3 maps to CMS-HCC V28 109. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software
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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)
D64.3
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther sideroblastic anemias
A group of anemias characterized by abnormal iron accumulation in red blood cells that are not caused by drugs, toxins, or genetic factors.
Buddy Insight
Other sideroblastic anemias captures sideroblastic anemia cases that do not fit into hereditary (D64.
CMS-HCC V28
MappedHCC 109
Code-level coefficient reference
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 075
Code-level coefficient reference
ESRD/PACE
MappedHCC 48
Code-level coefficient reference
RXHCC
MappedHCC 96
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- Sideroblastic anemia NOS
- Pyridoxine-responsive sideroblastic anemia NEC
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
Includes
OfficialNo Includes notes are included in this display for D64.3. 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
OfficialNo Code First sequencing instructions are included in this display for D64.3. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for D64.3. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for D64.3. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 D64.3 an HCC code?
Yes. D64.3 (Other sideroblastic anemias) maps to HCC 109, Acquired Hemolytic, Aplastic, and Sideroblastic Anemias under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 1.144. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: D64.3 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
- D64.3
- Description
- Other sideroblastic anemias
- HCC (V28)
- HCC 109 — Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
- RAF reference coefficient
- 1.144
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 D64.3 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for D64.3
For D64.3, 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
D64.3 is the ICD-10-CM diagnosis code for other sideroblastic anemias. A group of anemias characterized by abnormal iron accumulation in red blood cells that are not caused by drugs, toxins, or genetic factors. D64.3 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, D64.3 maps to Acquired Hemolytic, Aplastic, and Sideroblastic Anemias (HCC 109) with a source-labeled community, non-dual, aged reference coefficient of 1.144. No V24 mapping is shown for D64.3; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
This is a catch-all code for sideroblastic anemias not classified elsewhere. For D64.3, 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. 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, source-labeled coefficient references, and MEAT documentation criteria for D64.3 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a catch-all code for sideroblastic anemias not classified elsewhere
- •Ensure the anemia is not secondary to drugs, toxins, or congenital conditions before assigning this code
Clinical Significance
Other sideroblastic anemias captures sideroblastic anemia cases that do not fit into hereditary (D64.0), disease-related secondary (D64.1), or drug/toxin-related secondary (D64.2) categories. This includes idiopathic acquired sideroblastic anemia without meeting full criteria for myelodysplastic syndrome, pyridoxine-responsive sideroblastic anemia of unclear etiology, and sideroblastic anemia associated with mitochondrial disorders not otherwise classified. The common feature is impaired heme synthesis with ring sideroblast formation on bone marrow examination.
Documentation Requirements
- ✓Document bone marrow biopsy findings showing ring sideroblasts with percentage quantification.
- ✓Record the evaluation performed to exclude hereditary, drug-induced, and disease-related causes.
- ✓Include hemoglobin level, mean corpuscular volume, reticulocyte count, serum iron studies, and ferritin level.
- ✓Document any pyridoxine trial results to assess responsiveness.
- ✓Note whether myelodysplastic syndrome has been considered and excluded through cytogenetic analysis and morphological review.
Commonly Confused Codes
- •D64.0 (Hereditary sideroblastic anemia) requires confirmed genetic basis.
- •D64.1 (Secondary sideroblastic anemia due to disease) has an identifiable underlying condition.
- •D64.2 (Secondary sideroblastic anemia due to drugs and toxins) has an identified causative agent.
- •D46.1 (Refractory anemia with ring sideroblasts) is a myelodysplastic syndrome with distinct cytogenetic and morphologic criteria.
- •D64.9 (Anemia, unspecified) does not capture the sideroblastic mechanism.