2027 ICD-10-CM Diagnosis Code D69.41Evans syndrome
ICD-10-CM Codes›D50–D89›D65-D69›D69
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 112
- Chronic Condition
D69.41 is a billable ICD-10-CM diagnosis code for evans syndrome. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 813. 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 53 closely related codes. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Coagulation and hemorrhagic disorders.
For Medicare Advantage risk adjustment, D69.41 maps to CMS-HCC Category 112 (Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions) under the V28 model, adding a risk factor of about 0.450 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
D69.41 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.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Evans syndrome
- Warm autoimmune hemolytic anemia
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to D69.41: its own notes plus those printed at D69.4, D69, and Chapter 3. A note printed at a category, block or chapter applies to every code under it.
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
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.
- 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 D69.41, its category, or a range that includes it.
Excludes1 1
These codes carry an Excludes1 note naming D69.41: they are not reported together with it, unless the two conditions are unrelated.
Excludes2 2
These codes carry an Excludes2 note naming D69.41: its condition is not part of those codes, and both may be reported when the patient has both.
- D59.1 Other autoimmune hemolytic anemiasEvans syndrome (D69.41)
- Block R70-R79 Abnormal findings on examination of blood, without diagnosisabnormalities of platelets and thrombocytes (D69.-) names D69.-, which includes this code
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Evans syndrome D69.41
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Evans Syndrome
a rare, chronic and relapsing autoimmune disorder of unknown etiology, characterized by the presence of immune thrombocytopenia and autoimmune hemolytic anemia.
Patient EducationClinical
Platelet Disorders
Platelets, also known as thrombocytes, are blood cells. They form in your bone marrow, a sponge-like tissue in your bones. Platelets play a major role in blood clotting. Normally, when one of your blood vessels is injured, you start to bleed.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert D69.41 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About D69.41Overview
What is the ICD-10 code for evans syndrome?
The ICD-10-CM code for evans syndrome is D69.41 (sometimes written as D6941). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is D69.41 (Other primary thrombocytopenia) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report evans syndrome on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does D69.41 group to?
When evans syndrome is the principal diagnosis on an inpatient stay, it groups to MS-DRG 813 (coagulation Disorders), which carries a relative weight of 1.5279. Higher weights mean higher Medicare reimbursement.
Is D69.41 a CC or MCC?
CMS lists D69.41 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 53 closely related codes in its exclusion list.
Can D69.41 be reported with P61.0?
Not as a rule. The Excludes1 note at D69.4, which applies to D69.41, lists "transient neonatal thrombocytopenia (P61.0)". 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 D69.41?
D69.41 (evans syndrome) maps to CMS-HCC Category 112 (Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions), commonly written as HCC 112, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 48 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does D69.41 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, D69.41 adds a risk adjustment factor of about 0.450 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.450 to 0.708 depending on the payment segment). A more severe related category (HCC 111) supersedes it when both are reported. See the full factor table on the HCC 112 category page.
