ICD-10 D61.818
Billable / Specific HCC v28: 47 CCOther pancytopenia
About ICD-10-CM D61.818
ICD-10-CM code D61.818 represents Other pancytopenia. This is a billable/specific code in the Blood and Blood-forming Organs chapter (block D61). The 2026 edition of ICD-10-CM D61.818 became effective on October 1, 2025.
Coding Tips for D61.818
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
D61.818 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.
D61.818 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
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, CC
codes Other pancytopenia. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for D61.818
Local Coverage Determinations (LCDs) from CMS MACs that list D61.818 as a covered diagnosis.
Showing top 10 of 1,225 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing D61.818.
1 Cigna
5 Medicare
CPT Codes Commonly Billed with D61.818
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 D61.818 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 |
|---|---|---|
| D61.818 | 28419 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To D61.818
Other codes in section D60-D64 (Aplastic and other anemias and other bone marrow failure syndromes).
ICD-10 D61.818, Billing FAQ
Is ICD-10 code D61.818 billable? +
Yes, D61.818 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does D61.818 affect Medicare Advantage HCC risk adjustment? +
Yes. D61.818 maps to CMS-HCC v28 category 47. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is D61.818 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What ICD-9 codes does D61.818 map to? +
Per CMS GEMs, D61.818 maps to ICD-9 codes: 28419. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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