D46.5 exists in the World Health Organization's base ICD-10 classification, but was never adopted into ICD-10-CM (the United States clinical modification used for medical billing). It cannot be used on a US claim. Reference information from the official WHO classification is shown below.
Code
D46.5
Title
Refractory anaemia with multi-lineage dysplasia
Source: WHO ICD-10 (International Statistical Classification of Diseases and Related Health Problems, 10th Revision)