ICD-10 D61.811
Billable / Specific HCC v28: 47 MCCOther drug-induced pancytopenia
About ICD-10-CM D61.811
ICD-10-CM code D61.811 represents Other drug-induced pancytopenia. This is a billable/specific code in the Blood and Blood-forming Organs chapter (block D61). The 2026 edition of ICD-10-CM D61.811 became effective on October 1, 2025.
Coding Tips for D61.811
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
D61.811 is a CMS-HCC v28 risk-adjustment code (category 47). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
D61.811 is designated MCC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-MCC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag MCC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Type 2 Excludes
Not included here, the excluded code is not part of D61.811, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- aplastic anemia due to drugs (D61.1)
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, MCC
codes Other drug-induced pancytopenia. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for D61.811
Local Coverage Determinations (LCDs) from CMS MACs that list D61.811 as a covered diagnosis.
Showing top 10 of 671 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing D61.811.
5 Medicare
CPT Codes Commonly Billed with D61.811
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert D61.811 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| D61.811 | 28412 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To D61.811
Other codes in section D60-D64 (Aplastic and other anemias and other bone marrow failure syndromes).
ICD-10 D61.811, Billing FAQ
Is ICD-10 code D61.811 billable? +
Yes, D61.811 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 2 Excludes for D61.811? +
Type 2 Excludes (may be coded together when both conditions exist): aplastic anemia due to drugs (D61.1)
Does D61.811 affect Medicare Advantage HCC risk adjustment? +
Yes. D61.811 maps to CMS-HCC v28 category 47. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is D61.811 a CC or MCC for inpatient DRG? +
Yes, this code is designated as MCC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What ICD-9 codes does D61.811 map to? +
Per CMS GEMs, D61.811 maps to ICD-9 codes: 28412. Useful for legacy data review and historical claim analysis.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team