What is ICD-10 code D69.41?

D69.41 is the ICD-10-CM diagnosis code for Evans syndrome. A rare autoimmune condition where the body simultaneously destroys both red blood cells and platelets, causing anemia and bleeding problems. D69.41 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. D69.41 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. D69.41 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. D69.41 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 D69.41 map to under V28?

D69.41 maps to CMS-HCC V28 HCC 112 (Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM D69.41: Evans syndrome

D69.41 maps to CMS-HCC V28 112. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · free HCC 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 lookupD69.41Effective 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) / Coagulation defects, purpura and other hemorrhagic conditions (D65-D69)

D69.41

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

Evans syndrome

A rare autoimmune condition where the body simultaneously destroys both red blood cells and platelets, causing anemia and bleeding problems.

Buddy Insight

CMS-HCC V28

Mapped

HCC 112

Immune Thrombocytopenia and S...

Code-level coefficient reference

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

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

D69Purpura and other hemorrhagic conditions

D69.4Other primary thrombocytopenia

D69.41Evans syndrome

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for D69.41 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for D69.41 in this effective period.

Related Child Codes

Official

D69.42Congenital and hereditary thrombocytopenia purpura

D69.49Other primary thrombocytopenia

Includes

Official

ICD-10-CM does not list Includes notes for D69.41 in this effective period.

Excludes 1

Official

transient neonatal thrombocytopenia (P61.0)
Wiskott-Aldrich syndrome (D82.0)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for D69.41 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for D69.41 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for D69.41 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Document concurrent thrombocytopenia with positive antiplatelet antibodies AND autoimmune hemolytic anemia with positive direct antiglobulin test (Coombs test).

Record reticulocyte count, LDH, haptoglobin, and bilirubin confirming hemolysis alongside platelet counts.

Note treatment history including response to corticosteroids, IVIG, rituximab, and splenectomy.

MEAT Support

HCC Buddy guidance

Document concurrent thrombocytopenia with positive antiplatelet antibodies AND autoimmune hemolytic anemia with positive direct antiglobulin test (Coombs test).

Record reticulocyte count, LDH, haptoglobin, and bilirubin confirming hemolysis alongside platelet counts.

Note treatment history including response to corticosteroids, IVIG, rituximab, and splenectomy.

Audit Caution

HCC Buddy guidance

Evans syndrome requires documentation of BOTH autoimmune thrombocytopenia and autoimmune hemolytic anemia — do not assign for isolated ITP or isolated AIHA. The two cytopenias may not occur simultaneously

sequential presentation over time still qualifies. Screen for underlying lymphoproliferative or autoimmune disorders.

Common Mistakes

HCC Buddy guidance

D69.3 (Immune thrombocytopenic purpura) — isolated ITP without hemolytic anemia component

D59.1 (Other autoimmune hemolytic anemias) — isolated AIHA without thrombocytopenia

D65 (DIC) — may cause both anemia and thrombocytopenia but through consumptive mechanism.

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 D69.41 an HCC code?

Yes. D69.41 (Evans syndrome) maps to HCC 112, Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.450. 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: D69.41 is billable and maps to V28 HCC 112, Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: D69.41
Description: Evans syndrome
HCC (V28): HCC 112 — Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions
RAF reference coefficient: 0.450
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 112, Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions

0.450

ESRDHCC 48, Coagulation Defects and Other Specified Hematological Disorders

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 D69.41 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for D69.41

For D69.41 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 D69.41 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

Get the V28 mapping + MEAT cheat sheet

One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.

Free PDF. No card. Unsubscribe anytime.

What This Code Means

D69.41 is the ICD-10-CM diagnosis code for evans syndrome. A rare autoimmune condition where the body simultaneously destroys both red blood cells and platelets, causing anemia and bleeding problems. D69.41 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, D69.41 maps to Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions (HCC 112) with a source-labeled community, non-dual, aged reference coefficient of 0.450. No V24 mapping is shown for D69.41; use the applicable model and payment year when reviewing the V28 mapping. 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. 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.

Ensure both hemolytic anemia and thrombocytopenia are documented and coded separately. Because D69.41 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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 D69.41 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Ensure both hemolytic anemia and thrombocytopenia are documented and coded separately
•Distinguish from ITP alone by confirming evidence of hemolysis

Clinical Significance

Evans syndrome is an autoimmune condition characterized by the simultaneous or sequential combination of immune thrombocytopenic purpura and autoimmune hemolytic anemia, sometimes with autoimmune neutropenia. It is more resistant to treatment than isolated ITP or autoimmune hemolytic anemia and carries a higher morbidity and mortality. The condition may be primary or secondary to lymphoproliferative disorders or autoimmune diseases.

Documentation Requirements

✓Document concurrent thrombocytopenia with positive antiplatelet antibodies AND autoimmune hemolytic anemia with positive direct antiglobulin test (Coombs test).
✓Record reticulocyte count, LDH, haptoglobin, and bilirubin confirming hemolysis alongside platelet counts.
✓Note treatment history including response to corticosteroids, IVIG, rituximab, and splenectomy.

Commonly Confused Codes

•D69.3 (Immune thrombocytopenic purpura): isolated ITP without hemolytic anemia component
•D59.1 (Other autoimmune hemolytic anemias): isolated AIHA without thrombocytopenia
•D65 (DIC): may cause both anemia and thrombocytopenia but through consumptive mechanism.