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D47.4 ICD-10-CM Code: Osteomyelofibrosis

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

Coding at a Glance

Tabular directives
4 inclusion terms · 2 Excludes1
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 46 · RxHCC V08 category 16

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 814 — RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC (MDC 16)
  • MS-DRG 815 — RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC (MDC 16)
  • MS-DRG 816 — RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC (MDC 16)

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 19 — Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers (supersedes HCC 20, HCC 21, HCC 22, HCC 23)

Other models: CMS-HCC V22 HCC 46 · RxHCC V08 HCC 16

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 D47.4 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 D47.4 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Chronic idiopathic myelofibrosis
  • Myelofibrosis (idiopathic) (with myeloid metaplasia)
  • Myelosclerosis (megakaryocytic) with myeloid metaplasia
  • Secondary myelofibrosis in myeloproliferative disease

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 D47.4

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

Before you code D47.4

  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 D47.4. 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 D47.4’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.

    ReviewC94.4, D49

Consider D47.4. 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 D47.4(2 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with D47.4: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareC94.4, 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 D47.4 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).

ReviewC94.4, 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

Osteomyelofibrosis is a billable ICD-10-CM diagnosis code (D47.4).

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 (7)

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 D47.4 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: D61.82 — Myelophthisis, D75.81 — Myelofibrosis.

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

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 3 MS-DRGs: DRG 814 (MDC 16), DRG 815 (MDC 16), DRG 816 (MDC 16).

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 (Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers) for risk-adjusted payment.

C91.31 — Prolymphocytic leukemia of B-cell type, in remission, C91.32 — Prolymphocytic leukemia of B-cell type, in relapse, C91.50 — Adult T-cell lymphoma/leukemia (HTLV-1-associated) not having achieved remission, C91.51 — Adult T-cell lymphoma/leukemia (HTLV-1-associated), in remission, C91.52 — Adult T-cell lymphoma/leukemia (HTLV-1-associated), in relapse, C91.60 — Prolymphocytic leukemia of T-cell type not having achieved remission, C91.61 — Prolymphocytic leukemia of T-cell type, in remission, C91.62 — Prolymphocytic leukemia of T-cell type, in relapse, C94.6 — Myelodysplastic disease, not elsewhere classified, D46.0 — Refractory anemia without ring sideroblasts, so stated, D46.1 — Refractory anemia with ring sideroblasts, D46.20 — Refractory anemia with excess of blasts, unspecified, D46.21 — Refractory anemia with excess of blasts 1, D46.4 — Refractory anemia, unspecified, D46.9 — Myelodysplastic syndrome, unspecified, D46.A — Refractory cytopenia with multilineage dysplasia, D46.B — Refractory cytopenia with multilineage dysplasia and ring sideroblasts, D46.C — Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality, D46.Z — Other myelodysplastic syndromes, D75.81 — Myelofibrosis, +47 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, Lung and Other Severe Cancers, Lymphoma and Other Cancers, Bladder, Colorectal, and Other Cancers, Prostate, Breast, and Other Cancers and Tumors

Same clinical category (CCSR)

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

D44.7 — Neoplasm of uncertain behavior of aortic body and other paraganglia, D44.9 — Neoplasm of uncertain behavior of unspecified endocrine gland, D45 — Polycythemia vera, 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, D47.9 — Neoplasm of uncertain behavior of lymphoid, hematopoietic and related tissue, unspecified, D47.Z1 — Post-transplant lymphoproliferative disorder (PTLD), D47.Z2 — Castleman disease, D47.Z9 — Other specified neoplasms of uncertain behavior of lymphoid, hematopoietic and related tissue, D48.0 — Neoplasm of uncertain behavior of bone and articular cartilage, D48.1 — Neoplasm of uncertain behavior of connective and other soft tissue, D48.110 — Desmoid tumor of head and neck, D48.111 — Desmoid tumor of chest wall, D48.112 — Desmoid tumor, intrathoracic, D48.113 — Desmoid tumor of abdominal wall, +100 more

Same Index main term, other category

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

C94.4 — Acute panmyelosis with myelofibrosis (acute), D75.81 — Myelofibrosis, D75.89 — Other specified diseases of blood and blood-forming organs, G35.D — Multiple sclerosis, unspecified (disseminated, of nervous system)

Contextual Map

Every relationship of D47.4 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 D47.4 with these 3 related codes in Claim Check

Hierarchy

Excludes1

Referenced by Excludes1 notes

  • D61.82 — Myelophthisis[Excludes1]: “myelofibrosis with myeloid metaplasia (D47.4)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
  • D75.81 — Myelofibrosis[Excludes1]: “myelofibrosis with myeloid metaplasia (D47.4)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 19 — Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers [CMS-HCC]: “Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers — supersedes HCC 20 (Lung and Other Severe Cancers), HCC 21 (Lymphoma and Other Cancers), HCC 22 (Bladder, Colorectal, and Other Cancers), HCC 23 (Prostate, Breast, and Other Cancers and Tumors)”— CMS-HCC V28 · 2026

MS-DRG Grouper

MDC crossing

  • MDC 16 — Diseases and Disorders of Blood, Blood Forming Organs and Immunologic Disorders[MDC crossing]: “Diseases and Disorders of Blood, Blood Forming Organs and Immunologic Disorders — 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. 1,614 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Myelofibrosis, idiopathic (chronic)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Myelofibrosis, secondary, in myeloproliferative disease[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Myelofibrosis, with myeloid metaplasia[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Myelosclerosis, megakaryocytic[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Myelosclerosis, megakaryocytic, with myeloid metaplasia[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Myelosclerosis, with myeloid metaplasia[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Osteomyelofibrosis[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (13)

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. "D47.4 — Osteomyelofibrosis." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/d47.4-osteomyelofibrosis

Change history

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

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.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to D47.4 in its code family, with their registry titles.

View all codes in the D47 family