2026 ICD-10-CM Diagnosis Code D46.ARefractory cytopenia with multilineage dysplasia

ICD-10-CM Codes›C00–D49›D37-D48›D46

ICD-10-CM D46.A
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

D46.A is a billable ICD-10-CM diagnosis code for refractory cytopenia with multilineage dysplasia. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 811 through 812. Coders also document this condition as congenital progressive bone marrow failure, B-cell immunodeficiency, skeletal dysplasia syndrome. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Myelodysplastic syndrome (MDS).

For Medicare Advantage risk adjustment, D46.A maps to CMS-HCC Category 19 (Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers) under the V28 model, adding a risk factor of about 1.798 for a community, non-dual, aged beneficiary in payment year 2026.

Code Identity

ICD-10-CM Code
D46.A
Billable Status
Yes — Valid for Submission
Code Describes
Refractory cytopenia with multilineage dysplasia
Short Description
Refractory cytopenia with multilineage dysplasia
Same as the full description in the CMS dataset.
Parent Code
D46
Myelodysplastic syndromes

Code Classification

ChapterC00–D49Neoplasms
SectionD37-D48Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes
CategoryD46Myelodysplastic syndromes
This CodeD46.ARefractory cytopenia with multilineage dysplasia

Medicare Risk Adjustment (HCC)Billing

D46.A maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2026.

CMS-HCC V28 Category (Payment Model)
HCC 19— Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers
Payment HCC · PY 2026 one of 68 ICD-10-CM codes in this category
Risk Adjustment Factor (RAF) Weight
+1.798
community, non-dual, aged · ranges 0.957–1.989 across segments
Hierarchy
Superseded by HCC 17 and HCC 18
a more severe related category takes the payment when both are reported
Prior Model (CMS-HCC V24)
HCC 46
V24 retired V28 pays 100% of MA risk scores since PY 2026
Other CMS Models
PACE (CMS-HCC V22): HCC 46 · ESRD (V21): HCC 46 · ESRD (V24): HCC 46
ESRD V21 weights: 0.180 dialysis, 0.766–1.325 functioning graft · ESRD V24 weights: 0.223 dialysis, 0.748–4.064 functioning graft
Part D (RxHCC)
RxHCC 19 — Leukemias and Other Hematologic Cancers
also risk-adjusts in the Part D prescription drug model (V08)

Source: CMS Payment Year 2026 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Congenital progressive bone marrow failure, B-cell immunodeficiency, skeletal dysplasia syndrome
  • Immuno-osseous dysplasia
  • Myelodysplastic syndrome with low blasts

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR NEO068
Myelodysplastic syndrome (MDS)
Default principal diagnosis: inpatient Yes · outpatient Yes

Clinical InformationClinical

  • Myelodysplastic Syndromes

    clonal hematopoietic stem cell disorders characterized by dysplasia in one or more hematopoietic cell lineages. they predominantly affect patients over 60, are considered preleukemic conditions, and have high probability of transformation into acute myeloid leukemia.

Patient EducationClinical

Myelodysplastic Syndromes

Your bone marrow is the spongy tissue inside some of your bones, such as your hip and thigh bones. It contains immature cells, called stem cells. The stem cells can develop into the red blood cells that carry oxygen through your body, the white blood cells that fight infections, and the platelets that help with blood clotting.

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert D46.A to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
238.72 Low grde myelody syn les
Approximate The match is approximate rather than exact.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About D46.AOverview

What is the ICD-10 code for refractory cytopenia with multilineage dysplasia?

The ICD-10-CM code for refractory cytopenia with multilineage dysplasia is D46.A (sometimes written as D46A). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

Is D46.A (Myelodysplastic syndromes) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report refractory cytopenia with multilineage dysplasia on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does D46.A group to?

When refractory cytopenia with multilineage dysplasia is the principal diagnosis on an inpatient stay, it groups to MS-DRG 811, 812, with relative weights from 0.9182 to 1.4043 depending on complications. Higher weights mean higher Medicare reimbursement.

What is the ICD-9 equivalent of D46.A?

Under the General Equivalence Mappings, refractory cytopenia with multilineage dysplasia converts to ICD-9-CM 238.72 (low grde myelody syn les). The mapping is approximate, so confirm the match fits the documentation.

What HCC is D46.A?

D46.A (refractory cytopenia with multilineage dysplasia) maps to CMS-HCC Category 19 (Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers), commonly written as HCC 19, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2026. It mapped to HCC 46 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 19.

Does D46.A risk-adjust for Medicare Advantage payment?

Yes. When documented and reported on a Medicare Advantage encounter, D46.A adds a risk adjustment factor of about 1.798 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.957 to 1.989 depending on the payment segment). A more severe related category (HCC 17 and HCC 18) supersedes it when both are reported. See the full factor table on the HCC 19 category page.