D70.0
BillableCongenital agranulocytosis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D70.0 an HCC code?
Yes. D70.0 maps to Disorders of Immunity, Neutropenia under the CMS-HCC V28 risk adjustment model (and Disorders of Immunity 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 D70.0
For D70.0 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 D70.0 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D70.0 is the ICD-10-CM diagnosis code for congenital agranulocytosis. A rare inherited condition where a person is born with an inability to produce certain white blood cells called neutrophils. D70.0 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 other disorders of blood and blood-forming organs (d70-d77).
Under the CMS-HCC V28 risk adjustment model, D70.0 maps to Disorders of Immunity, Neutropenia (HCC 115) with a community, non-dual, aged base RAF weight of 0.369. Under the older CMS-HCC V24 model, D70.0 maps to Disorders of Immunity (HCC 47) with a community, non-dual, aged base RAF weight of 0.472. 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.
This is a congenital condition; verify the diagnosis is present from birth and not acquired later. Because D70.0 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 D70.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a congenital condition; verify the diagnosis is present from birth and not acquired later
- •Document family history when available as this is a genetic disorder
Clinical Significance
Congenital agranulocytosis, also known as Kostmann syndrome or severe congenital neutropenia, is a rare inherited bone marrow failure disorder characterized by severely reduced neutrophil counts from birth, leading to life-threatening bacterial infections. Patients require lifelong granulocyte colony-stimulating factor (G-CSF) therapy and have an increased risk of developing myelodysplastic syndrome or acute myeloid leukemia.
Documentation Requirements
- ✓Document absolute neutrophil count (typically <200/mcL), age of onset (infancy), genetic mutation if identified (HAX1, ELANE, G6PC3), G-CSF dosing and response, and infection history.
- ✓Record bone marrow biopsy findings showing maturation arrest at promyelocyte/myelocyte stage and screening for malignant transformation.