ICD-10 D67
Billable / Specific HCC v28: 46 MCCHereditary factor IX deficiency
About ICD-10-CM D67
ICD-10-CM code D67 represents Hereditary factor IX deficiency. This is a billable/specific code in the Blood and Blood-forming Organs chapter (block D67). The 2026 edition of ICD-10-CM D67 became effective on October 1, 2025.
Coding Tips for D67
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
D67 is a CMS-HCC v28 risk-adjustment code (category 46). 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.
D67 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.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under D67. Per CMS ICD-10-CM Tabular 2026.
- Christmas disease
- Factor IX deficiency (with functional defect)
- Hemophilia B
- Plasma thromboplastin component [PTC] deficiency
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 Hereditary factor IX deficiency. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for D67
Local Coverage Determinations (LCDs) from CMS MACs that list D67 as a covered diagnosis.
Showing top 10 of 33 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing D67.
2 Cigna
1 Medicare
CPT Codes Commonly Billed with D67
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- J7187 CMS LCD: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 CMS LCD
- J7201 CMS LCD: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 CMS LCD
- J7179 CMS LCD: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 CMS LCD
- J7194 CMS LCD: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 CMS LCD
- J7180 CMS LCD: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 CMS LCD
- J7175 CMS LCD: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 CMS LCD
- J7189 CMS LCD: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 CMS LCD
- J7209 CMS LCD: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 CMS LCD
- J7186 CMS LCD: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 CMS LCD
- J7182 CMS LCD: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 CMS LCD
Convert D67 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 |
|---|---|---|
| D67 | 2861 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To D67
Other codes in section D65-D69 (Coagulation defects, purpura and other hemorrhagic conditions).
ICD-10 D67, Billing FAQ
Is ICD-10 code D67 billable? +
Yes, D67 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to D67? +
ICD-10 D67 includes: Christmas disease; Factor IX deficiency (with functional defect); Hemophilia B, and 1 more clinical synonyms.
Does D67 affect Medicare Advantage HCC risk adjustment? +
Yes. D67 maps to CMS-HCC v28 category 46. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is D67 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 CPT codes are commonly billed with D67? +
Procedures frequently paired with D67 include: J7187, J7201, J7179, J7194, J7180.
What ICD-9 codes does D67 map to? +
Per CMS GEMs, D67 maps to ICD-9 codes: 2861. 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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