ICD-10 D69.49
Billable / Specific HCC v28: 48Other primary thrombocytopenia
About ICD-10-CM D69.49
ICD-10-CM code D69.49 represents Other primary thrombocytopenia. This is a billable/specific code in the Blood and Blood-forming Organs chapter (block D69). The 2026 edition of ICD-10-CM D69.49 became effective on October 1, 2025.
Coding Tips for D69.49
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
D69.49 is a CMS-HCC v28 risk-adjustment code (category 48). 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.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under D69.49. Per CMS ICD-10-CM Tabular 2026.
- Megakaryocytic hypoplasia
- Primary thrombocytopenia NOS
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.
Medicare LCD Coverage for D69.49
Local Coverage Determinations (LCDs) from CMS MACs that list D69.49 as a covered diagnosis.
Showing top 10 of 688 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing D69.49.
2 Cigna
5 Medicare
CPT Codes Commonly Billed with D69.49
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- J0840 CMS LCD: Billing and Coding: Immune Globulins CMS LCD
- J0850 CMS LCD: Billing and Coding: Immune Globulins CMS LCD
- 90371 CMS LCD: Billing and Coding: Immune Globulins CMS LCD
- 90375 CMS LCD: Billing and Coding: Immune Globulins CMS LCD
- J1573 CMS LCD: Billing and Coding: Immune Globulins CMS LCD
- J1569 CMS LCD: Billing and Coding: Immune Globulins CMS LCD
- J1459 CMS LCD: Billing and Coding: Immune Globulins CMS LCD
- J1557 CMS LCD: Billing and Coding: Immune Globulins CMS LCD
- J1556 CMS LCD: Billing and Coding: Immune Globulins CMS LCD
- J1560 CMS LCD: Billing and Coding: Immune Globulins CMS LCD
Convert D69.49 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 |
|---|---|---|
| D69.49 | 28730 | 10000 |
| D69.49 | 28739 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To D69.49
Other codes in section D65-D69 (Coagulation defects, purpura and other hemorrhagic conditions).
ICD-10 D69.49, Billing FAQ
Is ICD-10 code D69.49 billable? +
Yes, D69.49 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 D69.49? +
ICD-10 D69.49 includes: Megakaryocytic hypoplasia; Primary thrombocytopenia NOS.
Does D69.49 affect Medicare Advantage HCC risk adjustment? +
Yes. D69.49 maps to CMS-HCC v28 category 48. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with D69.49? +
Procedures frequently paired with D69.49 include: J0840, J0850, 90371, 90375, J1573.
What ICD-9 codes does D69.49 map to? +
Per CMS GEMs, D69.49 maps to ICD-9 codes: 28730, 28739. 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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