D67
BillableHereditary factor IX deficiency
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D67 an HCC code?
Yes. D67 maps to Hemophilia 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 D67
For D67to 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 D67 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D67 is the ICD-10-CM diagnosis code for hereditary factor ix deficiency. A hereditary bleeding disorder caused by deficiency or dysfunction of clotting factor IX, commonly known as hemophilia B or Christmas disease. D67 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 coagulation defects, purpura and other hemorrhagic conditions (d65-d69).
Under the CMS-HCC V28 risk adjustment model, D67 maps to Hemophilia (HCC 111) with a community, non-dual, aged base RAF weight of 0.565. Under the older CMS-HCC V24 model, D67 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.
Document the severity of the deficiency when available. Because D67 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 D67 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the severity of the deficiency when available
- •Code any associated complications or inhibitor development separately
Clinical Significance
Hereditary factor IX deficiency (Hemophilia B, also called Christmas disease) is an X-linked recessive bleeding disorder accounting for approximately 15-20% of hemophilia cases. Like Hemophilia A, severity is classified by factor activity levels. Treatment involves factor IX replacement products, and gene therapy has emerged as a potential option.
Documentation Requirements
- ✓Document factor IX activity levels and severity classification (severe, moderate, mild).
- ✓Record the specific factor IX replacement product used, dosing schedule, and any history of inhibitor development.
- ✓Note significant bleeding episodes, joint damage assessment, and current prophylaxis versus on-demand treatment strategy.
Commonly Confused Codes
- •D66 (Hereditary factor VIII deficiency/Hemophilia A) — same clinical presentation but different factor deficiency
- •D68.1 (Hereditary factor XI deficiency) — typically milder bleeding disorder with different inheritance pattern (autosomal)
- •D68.2 (Hereditary deficiency of other clotting factors) — captures rarer factor deficiencies.