Skip to main content

D45 ICD-10-CM Code: Polycythemia vera

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
3 Excludes1
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 48 · RxHCC V08 category 21

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 820 — LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC (MDC 17)
  • MS-DRG 821 — LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC (MDC 17)
  • MS-DRG 822 — LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC (MDC 17)
  • MS-DRG 823 — LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC (MDC 17)
  • MS-DRG 824 — LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC (MDC 17)
  • MS-DRG 825 — LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC (MDC 17)
  • MS-DRG 840 — LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC (MDC 17)
  • MS-DRG 841 — LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC (MDC 17)
  • MS-DRG 842 — LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC (MDC 17)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 23 — Prostate, Breast, and Other Cancers and Tumors

Other models: CMS-HCC V22 HCC 48 · RxHCC V08 HCC 21

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for D45 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on D45 itself; “inherited from” names the category or block whose note applies here.

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Coder workflow for D45

MedCoder structured workflow — derived from this code’s own official record

Before you code D45

  1. Confirm the documented site and behavior (this code’s block classifies uncertain behavior neoplasms), whether the site is primary or secondary, and whether the malignancy is current or a personal history: a previously excised malignancy with no further treatment and no evidence of disease is history, not current disease. Verify the site against the Table of Neoplasms. Neoplasm chapter guidelines (Guidelines I.C.2.a, I.C.2.d, I.C.2.m).

    See the Table of Neoplasms entries · Guide: Active cancer vs history of cancer →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with D45. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in D45’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewD75.0, D75.1, D49

Consider D45. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Anatomical site
At the most specific level the record states; a site the classification separates cannot be assumed from a procedure or a measurement.
Behavior and current-versus-history status
Malignant, in situ, benign or uncertain; primary or secondary; current disease or personal history (Guidelines I.C.2.m).

Official instructions as workflow

  • Excludes1 — check before selecting D45(3 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with D45: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareD75.0, D75.1, D49

    See the official tabular notes · Guidelines I.A.12.a

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition D45 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewD75.0, D75.1, D49

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Polycythemia vera is a billable ICD-10-CM diagnosis code (D45).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (3)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name D45 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 2 Excludes1 notes across 2 chapters: D75.1 — Secondary polycythemia, R71 — Abnormality of red blood cells.

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 2 Code Also instructions across 2 chapters: D47.02 — Systemic mastocytosis, I27.29 — Other secondary pulmonary hypertension.

These codes suggest coding this condition alongside when both are present.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 9 MS-DRGs: DRG 820 (MDC 17), DRG 821 (MDC 17), DRG 822 (MDC 17), DRG 823 (MDC 17), DRG 824 (MDC 17), DRG 825 (MDC 17), DRG 840 (MDC 17), DRG 841 (MDC 17), DRG 842 (MDC 17).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):NEO072 — Neoplasms of unspecified nature or uncertain behavior (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Prostate, Breast, and Other Cancers and Tumors) for risk-adjusted payment.

D43.2 — Neoplasm of uncertain behavior of brain, unspecified, D43.3 — Neoplasm of uncertain behavior of cranial nerves, D43.4 — Neoplasm of uncertain behavior of spinal cord, D43.8 — Neoplasm of uncertain behavior of other specified parts of central nervous system, D43.9 — Neoplasm of uncertain behavior of central nervous system, unspecified, D44.3 — Neoplasm of uncertain behavior of pituitary gland, D44.4 — Neoplasm of uncertain behavior of craniopharyngeal duct, D44.5 — Neoplasm of uncertain behavior of pineal gland, D44.6 — Neoplasm of uncertain behavior of carotid body, D44.7 — Neoplasm of uncertain behavior of aortic body and other paraganglia, D47.3 — Essential (hemorrhagic) thrombocythemia, D49.6 — Neoplasm of unspecified behavior of brain, Q85.00 — Neurofibromatosis, unspecified, Q85.01 — Neurofibromatosis, type 1, Q85.02 — Neurofibromatosis, type 2, Q85.03 — Schwannomatosis, Q85.09 — Other neurofibromatosis, Q85.1 — Tuberous sclerosis, Q85.81 — PTEN hamartoma tumor syndrome, Q85.82 — Other Cowden syndrome, +213 more

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic, Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid, Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers, Lung and Other Severe Cancers, Lymphoma and Other Cancers, Bladder, Colorectal, and Other Cancers

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Neoplasms of unspecified nature or uncertain behavior).

D44.10 — Neoplasm of uncertain behavior of unspecified adrenal gland, D44.11 — Neoplasm of uncertain behavior of right adrenal gland, D44.12 — Neoplasm of uncertain behavior of left adrenal gland, D44.2 — Neoplasm of uncertain behavior of parathyroid gland, D44.3 — Neoplasm of uncertain behavior of pituitary gland, D44.4 — Neoplasm of uncertain behavior of craniopharyngeal duct, D44.5 — Neoplasm of uncertain behavior of pineal gland, D44.6 — Neoplasm of uncertain behavior of carotid body, D44.7 — Neoplasm of uncertain behavior of aortic body and other paraganglia, D44.9 — Neoplasm of uncertain behavior of unspecified endocrine gland, D47.0 — Mast cell neoplasms of uncertain behavior, D47.01 — Cutaneous mastocytosis, D47.02 — Systemic mastocytosis, D47.09 — Other mast cell neoplasms of uncertain behavior, D47.1 — Chronic myeloproliferative disease, D47.2 — Monoclonal gammopathy, D47.3 — Essential (hemorrhagic) thrombocythemia, D47.4 — Osteomyelofibrosis, D47.9 — Neoplasm of uncertain behavior of lymphoid, hematopoietic and related tissue, unspecified, D47.Z1 — Post-transplant lymphoproliferative disorder (PTLD), +100 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Polycythemia”, “Erythremia”; these codes share that main term but sit in a different category of the Tabular List.

C94.0 — Acute erythroid leukemia, D75.0 — Familial erythrocytosis (benign), D75.1 — Secondary polycythemia, P61.1 — Polycythemia neonatorum (neonatorum)

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Fecal Occult Blood Test (FOBT), Gamma-glutamyl Transferase (GGT) Test, Iron Panel, Partial Thromboplastin Time (PTT) Test, Prothrombin Time Test and INR (PT/INR)

Contextual Map

Every relationship of D45 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run D45 with these 6 related codes in Claim Check

Hierarchy

Excludes1

Referenced by Excludes1 notes

Referenced by Code Also instructions

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 23 — Prostate, Breast, and Other Cancers and Tumors [CMS-HCC]— CMS-HCC V28 · 2026

MS-DRG Grouper (9)

MDC crossing

  • MDC 17 — Myeloproliferative Diseases and Disorders, Poorly Differentiated Neoplasms[MDC crossing]: “Myeloproliferative Diseases and Disorders, Poorly Differentiated Neoplasms — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 4,730 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Erythremia (acute), chronic[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Heilmeyer-Schoner disease[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Polycythemia (secondary), vera[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "D45 — Polycythemia vera." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/d45-polycythemia-vera

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Polycythemia vera

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.