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D69.49 ICD-10-CM Code: Other primary thrombocytopenia

D69.49 maps to CMS-HCC V28 112 (RAF 0.450). Documentation must support MEAT. 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) / Coagulation defects, purpura and other hemorrhagic conditions (D65-D69)

D69.49

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

Other primary thrombocytopenia

Low platelet counts caused by bone marrow problems or other primary disorders not classified elsewhere.

Buddy the Bee presenting code insight

Buddy Insight

Other primary thrombocytopenia captures primary platelet production or survival disorders not classified as ITP, Evans syndrome, or hereditary thrombocytopenia.

CMS-HCC V28

HCC 112

RAF 0.450

CMS-HCC V24

HCC 48

RAF 0.192

ACA/HHS

HCC 75

Varies by metal level

ESRD/PACE

HCC 48

RAF 0.063

RXHCC

N/A

—

Not mapped

Code Book Path

Official
D69Purpura and other hemorrhagic conditions
D69.4Other primary thrombocytopenia
D69.49Other primary thrombocytopenia

Inclusion Terms

Official
  • Megakaryocytic hypoplasia
  • Primary thrombocytopenia NOS

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for D69.49 in this effective period.

Related Child Codes

Official
D69.41Evans syndrome
D69.42Congenital and hereditary thrombocytopenia purpura

Includes

Official

ICD-10-CM does not list Includes notes for D69.49 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 D69.49 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for D69.49 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for D69.49 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Document the specific clinical features and laboratory findings differentiating this from ITP and inherited thrombocytopenias.
Record bone marrow biopsy results if performed (showing megakaryocyte number and morphology), serial platelet counts demonstrating the pattern, and exclusion of secondary causes.
Note the treatment approach and response.

MEAT Support

HCC Buddy guidance
Document the specific clinical features and laboratory findings differentiating this from ITP and inherited thrombocytopenias.
Record bone marrow biopsy results if performed (showing megakaryocyte number and morphology), serial platelet counts demonstrating the pattern, and exclusion of secondary causes.
Note the treatment approach and response.

Audit Caution

HCC Buddy guidance
This code requires documentation establishing a primary thrombocytopenic condition — do not use for unexplained thrombocytopenia without workup (use D69.6 instead).
Distinguish from secondary thrombocytopenia caused by medications, infections, or bone marrow infiltration.
Cyclic thrombocytopenia has a characteristic periodic pattern that should be documented.

Common Mistakes

HCC Buddy guidance
D69.3 (Immune thrombocytopenic purpura) — most common primary thrombocytopenia
D69.42 (Congenital/hereditary thrombocytopenia) — when inherited cause is identified
D69.6 (Thrombocytopenia, unspecified) — less specific code that should be avoided when a primary etiology is established.

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 D69.49 an HCC code?

Yes. D69.49 (Other primary thrombocytopenia) maps to Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions under the CMS-HCC V28 risk adjustment model (and Coagulation Defects and Other Specified Hematological Disorders under V24), with a community non-dual aged RAF of 0.450. It is billable for payment year 2026.

Coder answer: D69.49 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
D69.49
Description
Other primary thrombocytopenia
HCC (V28)
HCC 112 — Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions
RAF
0.450
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 112, Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions
0.450
V24HCC 48, Coagulation Defects and Other Specified Hematological Disorders
0.192
ESRDHCC 48, Coagulation Defects and Other Specified Hematological Disorders
0.063

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work D69.49 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for D69.49

For D69.49 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 D69.49 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

D69.49 is the ICD-10-CM diagnosis code for other primary thrombocytopenia. Low platelet counts caused by bone marrow problems or other primary disorders not classified elsewhere. D69.49 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, D69.49 maps to Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions (HCC 112) with a community, non-dual, aged base RAF weight of 0.450. Under the older CMS-HCC V24 model, D69.49 maps to Coagulation Defects and Other Specified Hematological Disorders (HCC 48) with a community, non-dual, aged base RAF weight of 0.192. 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.

Rule out secondary causes (medications, infections, splenomegaly) before assigning this code. Because D69.49 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 D69.49 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Rule out secondary causes (medications, infections, splenomegaly) before assigning this code
  • •Document the underlying mechanism if known (decreased production vs. increased destruction)

Clinical Significance

Other primary thrombocytopenia captures primary platelet production or survival disorders not classified as ITP, Evans syndrome, or hereditary thrombocytopenia. This includes conditions such as cyclic thrombocytopenia, amegakaryocytic thrombocytopenia, and other rare primary platelet disorders. It represents a diagnostically challenging category requiring hematology evaluation.

Documentation Requirements

  • ✓Document the specific clinical features and laboratory findings differentiating this from ITP and inherited thrombocytopenias.
  • ✓Record bone marrow biopsy results if performed (showing megakaryocyte number and morphology), serial platelet counts demonstrating the pattern, and exclusion of secondary causes.
  • ✓Note the treatment approach and response.

Commonly Confused Codes

  • •D69.3 (Immune thrombocytopenic purpura): most common primary thrombocytopenia
  • •D69.42 (Congenital/hereditary thrombocytopenia): when inherited cause is identified
  • •D69.6 (Thrombocytopenia, unspecified): less specific code that should be avoided when a primary etiology is established.

Child Codes

D69.41Evans syndrome
HCC 112
D69.42Congenital and hereditary thrombocytopenia purpura
HCC 112
D69.49Other primary thrombocytopenia
HCC 112

Code Hierarchy

└D69Purpura and other hemorrhagic conditions└D69.4Other primary thrombocytopenia└D69.49Other primary thrombocytopenia
└D69.49Other primary thrombocytopenia

Because D69.49 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

D69.49 maps to CMS-HCC V28 category 112, Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. Because D69.49 carries a payment HCC, you can see what it adds to a RAF score and check the documentation the chart needs before it is submitted.

Work D69.49 in HCC Buddy

Open D69.49 in the Code Book for the full Index-to-Tabular path, MEAT checklist, and V28 HCC mapping, or in the Encoder to code from a keyword search. Pro includes 7 days to try everything, no card required.

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