2027 ICD-10-CM Diagnosis Code D61.03Fanconi anemia
ICD-10-CM Codes›D50–D89›D60-D64›D61
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 109
- Chronic Condition
D61.03 is a billable ICD-10-CM diagnosis code for fanconi anemia. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 808 through 810. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 102 closely related codes. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Aplastic anemia.
For Medicare Advantage risk adjustment, D61.03 maps to CMS-HCC Category 109 (Acquired Hemolytic, Aplastic, and Sideroblastic Anemias) under the V28 model, adding a risk factor of about 1.144 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
D61.03 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 2027.
Source: CMS Payment Year 2027 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.
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to D61.03: its own notes plus those printed at D61 and Chapter 3. A note printed at a category, block or chapter applies to every code under it.
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Fanconi pancytopenia
- Fanconi's anemia
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
- Fanconi syndrome (E72.0-)
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- neutropenia (D70.-)
- autoimmune disease (systemic) NOS (M35.9)
- certain conditions originating in the perinatal period (P00-P96)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- human immunodeficiency virus [HIV] disease (B20)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Anemia (essential) (general) (hemoglobin deficiency) (infantile) (primary) (profound) D64.9
Fanconi ('s) D61.03
Disease, diseased See Also: Syndrome;
Fanconi ('s) D61.03
Fanconi ('s) anemia D61.03
Fanconi hypoplastic anemia D61.03
Fanconi panmyelopathy D61.03
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Fanconi Anemia
congenital disorder affecting all bone marrow elements, resulting in anemia; leukopenia; and thrombopenia, and associated with cardiac, renal, and limb malformations as well as dermal pigmentary changes. spontaneous chromosome breakage is a feature of this disease along with predisposition to leukemia. there are at least 7 complementation groups in fanconi anemia: fanca, fancb, fancc, fancd1, fancd2, fance, fancf, fancg, and fancl. (from online mendelian inheritance in man, http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=227650, august 20, 2004)
Patient EducationClinical
Aplastic Anemia
Aplastic anemia is a rare but serious blood disorder. If you have it, your bone marrow doesn't make enough new blood cells. It happens when there is damage to stem cells inside your bone marrow. There are different types of aplastic anemia, including Fanconi anemia.
The full article covers:
- What is aplastic anemia?
- What causes aplastic anemia?
- What are the symptoms of aplastic anemia?
- What other problems can aplastic anemia cause?
- How is aplastic anemia diagnosed?
- What are the treatments for aplastic anemia?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Code History & ChangesHistory
Replacement D61.03 replaces the following previously assigned code(s):
- D61.09 - Other constitutional aplastic anemia
Questions About D61.03Overview
What is the ICD-10 code for fanconi anemia?
The ICD-10-CM code for fanconi anemia is D61.03 (sometimes written as D6103). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is D61.03 (Constitutional aplastic anemia) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report fanconi anemia on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does D61.03 group to?
When fanconi anemia is the principal diagnosis on an inpatient stay, it groups to MS-DRG 808, 809, 810, with relative weights from 1.0749 to 2.1706 depending on complications. Higher weights mean higher Medicare reimbursement.
Is D61.03 a CC or MCC?
CMS lists D61.03 as a CC (complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 102 closely related codes in its exclusion list.
Can D61.03 be reported with a code from E72.0?
Not as a rule. The Excludes1 note on D61.03 lists "Fanconi syndrome (E72.0-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What HCC is D61.03?
D61.03 (fanconi anemia) maps to CMS-HCC Category 109 (Acquired Hemolytic, Aplastic, and Sideroblastic Anemias), commonly written as HCC 109, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. 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 96.
Does D61.03 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, D61.03 adds a risk adjustment factor of about 1.144 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.529 to 1.815 depending on the payment segment). HCC 109 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 109 category page.
