D69.41
BillableEvans syndrome
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D69.41 an HCC code?
Yes. D69.41 maps to Von Willebrand Disease and Other Coagulation Defects under the CMS-HCC V28 risk adjustment model (and Coagulation Defects and Other Specified 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 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.
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 Von Willebrand Disease and Other Coagulation Defects (HCC 112) with a community, non-dual, aged base RAF weight of 0.247. Under the older CMS-HCC V24 model, D69.41 maps to Coagulation Defects and Other Specified Hematological Disorders (HCC 48) with a community, non-dual, aged base RAF weight of 0.209. 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.
Ensure both hemolytic anemia and thrombocytopenia are documented and coded separately. Because D69.41 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 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.