D76.3
BillableOther histiocytosis syndromes
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D76.3 an HCC code?
Yes. D76.3 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 D76.3
For D76.3to 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 D76.3 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D76.3 is the ICD-10-CM diagnosis code for other histiocytosis syndromes. A group of rare disorders involving abnormal accumulation or dysfunction of immune cells in various body tissues. D76.3 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, D76.3 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, D76.3 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.
Specify the type of histiocytosis syndrome when documented. Because D76.3 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 D76.3 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Specify the type of histiocytosis syndrome when documented
- •May require additional codes for affected organ systems
Clinical Significance
Other histiocytosis syndromes encompass a heterogeneous group of rare disorders characterized by abnormal accumulation or dysfunction of histiocytes (tissue macrophages) in various organs. These conditions include sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease), xanthogranuloma, and other non-Langerhans cell histiocytoses that can cause significant organ damage depending on tissue involvement.
Documentation Requirements
- ✓Documentation should specify the exact type of histiocytosis syndrome when known, affected organ systems, biopsy results confirming histiocyte infiltration, immunohistochemistry staining profile (CD68+, S100-), and extent of disease.
- ✓Include imaging findings showing affected organs and the treatment approach, whether observation, chemotherapy, or surgical intervention.
Commonly Confused Codes
- •D76.1 (hemophagocytic lymphohistiocytosis, which specifically involves hemophagocytosis), C96.0 (multifocal Langerhans-cell histiocytosis, which is classified as neoplastic), C96.5 (multifocal and unisystem Langerhans-cell histiocytosis), C96.6 (unifocal Langerhans-cell histiocytosis), D76.2 (infection-associated hemophagocytic syndrome).