2027 ICD-10-CM Diagnosis Code D61.09Other constitutional aplastic anemia

ICD-10-CM Codes›D50–D89›D60-D64›D61

ICD-10-CM D61.09
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

D61.09 is a billable ICD-10-CM diagnosis code for other constitutional aplastic 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, D61.09 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

ICD-10-CM Code
D61.09
Billable Status
Yes — Valid for Submission
Code Describes
Other constitutional aplastic anemia
Short Description
Other constitutional aplastic anemia
Same as the full description in the CMS dataset.
Parent Code
D61.0
Constitutional aplastic anemia

Code Classification

ChapterD50–D89Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
SectionD60-D64Aplastic and other anemias and other bone marrow failure syndromes
CategoryD61Other aplastic anemias and other bone marrow failure syndromes
This CodeD61.09Other constitutional aplastic anemia

Medicare Risk Adjustment (HCC)Billing

D61.09 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.

CMS-HCC V28 Category (Payment Model)
HCC 109— Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
Payment HCC · PY 2027 one of 37 ICD-10-CM codes in this category
Risk Adjustment Factor (RAF) Weight
+1.144
community, non-dual, aged · ranges 0.529–1.815 across segments
Hierarchy
Top of its hierarchy
HCC 109 is not superseded by any other condition category
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 96 — Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
also risk-adjusts in the Part D prescription drug model (V08)

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.

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • AMeD syndrome
  • Autosomal dominant aplasia and myelodysplasia
  • Complete deafness
  • Congenital deafness
  • Congenital progressive bone marrow failure, B-cell immunodeficiency, skeletal dysplasia syndrome
  • Constitutional aplastic anemia
  • Constitutional aplastic anemia with malformation
  • Estren-Dameshek anemia
  • Fanconi anemia of complementation group C
  • Fanconi's anemia
  • Immuno-osseous dysplasia
  • Myelodysplastic syndrome with low blasts
  • Pancytopenia with developmental delay syndrome
  • WT limb blood syndrome

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to D61.09: 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.

  • Pancytopenia with malformations

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.

From D61 Other aplastic anemias and other bone marrow failure syndromes applies to 13 codes
From Chapter 3 (D50-D89) Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism applies to 324 codes
  • 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.

Referenced in Other NotesGuidance

Instructional notes printed at other codes that name D61.09, its category, or a range that includes it.

Excludes1 1

These codes carry an Excludes1 note naming D61.09: they are not reported together with it, unless the two conditions are unrelated.

  • E79 Disorders of purine and pyrimidine metabolism
    Fanconi's anemia (D61.09)

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 BLD003
Aplastic anemia
Default principal diagnosis: inpatient Yes · outpatient Yes

Clinical InformationClinical

  • Anemia, Diamond-Blackfan

    a rare congenital hypoplastic anemia that usually presents early in infancy. the disease is characterized by a moderate to severe macrocytic anemia, occasional neutropenia or thrombocytosis, a normocellular bone marrow with erythroid hypoplasia, and an increased risk of developing leukemia. (curr opin hematol 2000 mar;7(2):85-94)

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.

Convert D61.09 to ICD-9-CMHistory

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

ICD-9-CM
284.09 Const aplastc anemia NEC
Exact Match The mapping is direct, with no qualifiers.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About D61.09Overview

What is the ICD-10 code for other constitutional aplastic anemia?

The ICD-10-CM code for other constitutional aplastic anemia is D61.09 (sometimes written as D6109). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is D61.09 (Constitutional aplastic anemia) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report other constitutional aplastic anemia on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What MS-DRG does D61.09 group to?

When other constitutional aplastic 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 D61.09 a CC or MCC?

CMS lists D61.09 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.

What is the ICD-9 equivalent of D61.09?

Under the General Equivalence Mappings, other constitutional aplastic anemia converts to ICD-9-CM 284.09 (const aplastc anemia NEC). The mapping is a direct match.

What HCC is D61.09?

D61.09 (other constitutional aplastic 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 D61.09 risk-adjust for Medicare Advantage payment?

Yes. When documented and reported on a Medicare Advantage encounter, D61.09 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.