D76.2
BillableHemophagocytic syndrome, infection-associated
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D76.2 an HCC code?
Yes. D76.2 maps to Disorders of Immunity under the V24 model but is not retained in V28.
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 D76.2
For D76.2to 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 D76.2 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D76.2 is the ICD-10-CM diagnosis code for hemophagocytic syndrome, infection-associated. A serious condition where immune cells abnormally consume blood cells and other cells in the body, triggered by an infection. D76.2 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 older CMS-HCC V24 model, D76.2 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.
Always identify and code the underlying infection separately. Because D76.2 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 D76.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Always identify and code the underlying infection separately
- •This is a secondary diagnosis; ensure the primary infection is documented and coded
Clinical Significance
Hemophagocytic syndrome, infection-associated, is a severe hyperinflammatory condition triggered by an infectious agent where the immune system becomes overactivated, causing macrophages to engulf healthy blood cells. Common infectious triggers include Epstein-Barr virus, cytomegalovirus, and other herpes viruses, though bacterial, fungal, and parasitic infections can also precipitate this syndrome.
Documentation Requirements
- ✓Documentation must identify and specify the triggering infectious organism, include evidence of hemophagocytosis (elevated ferritin, cytopenias, splenomegaly, bone marrow findings), and describe the treatment approach.
- ✓The underlying infection must be coded separately as a primary or additional diagnosis.
- ✓Include laboratory values supporting the diagnosis such as ferritin levels, triglycerides, and fibrinogen.
Use Additional Code
- code to identify infectious agent or disease.
Commonly Confused Codes
- •D76.1 (hemophagocytic lymphohistiocytosis used when the trigger is genetic/primary or unspecified), D76.3 (other histiocytosis syndromes without hemophagocytic features), A27.0 (leptospirosis with hemophagocytic features should still use D76.2 as an additional code), D89.810-D89.813 (graft-versus-host disease which may mimic hemophagocytic syndrome).