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D64.3 ICD-10-CM Code: Other sideroblastic anemias

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

Coding at a Glance

Tabular directives
2 inclusion terms · 2 Excludes1
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 48 · RxHCC V08 category 96

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 811 — RED BLOOD CELL DISORDERS WITH MCC (MDC 16)
  • MS-DRG 812 — RED BLOOD CELL DISORDERS WITHOUT 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 109 — Acquired Hemolytic, Aplastic, and Sideroblastic Anemias

Other models: CMS-HCC V22 HCC 48 · RxHCC V08 HCC 96

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 D64.3 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 D64.3 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Sideroblastic anemia NOS
  • Pyridoxine-responsive sideroblastic anemia NEC

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 D64.3

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

Before you code D64.3

  1. “Other” (NEC) means the condition is specified in the record but no dedicated code captures it. Confirm the documented form is not one a sibling code names before settling on D64.3; if the record states no specifics at all, the unspecified sibling applies instead. “Other” codes are for documented conditions the classification gives no specific code; “unspecified” codes are for records lacking the detail (Guidelines I.A.9.a, I.A.9.b).

    ReviewD64.0, D64.1, D64.2, D64.4

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with D64.3. 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 D64.3’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.

    ReviewD46

Consider D64.3. 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).
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes1 — check before selecting D64.3(2 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with D64.3: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareD46

    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 D64.3 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).

ReviewD46

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

Other sideroblastic anemias is a billable ICD-10-CM diagnosis code (D64.3).

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 (6)

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.

Official Coding Guidelines

No excerpt in the ICD-10-CM Official Guidelines names this code specifically. Its chapter carries only this chapter-wide note:

Chapter 3: Disease of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)

Reserved for future guideline expansion

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 D64.3 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 3 Excludes1 notes across 2 chapters: E53.1 — Pyridoxine deficiency, E83.1 — Disorders of iron metabolism, R71 — Abnormality of red blood cells (via D64.-).

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

Referenced by 23 Code First instructions across 3 chapters: I21.A1 — Myocardial infarction type 2 (via D64.-), M90.5 — Osteonecrosis in diseases classified elsewhere (via D64.-), T36 — Poisoning by, adverse effect of and underdosing of systemic antibiotics (via D64.-), T36-T39 — Antibiotics & Anti-infectives (T36-T39) (via D64.-), T36-T50 — Poisoning by, adverse effects of and underdosing of drugs, medicaments and biological substances (T36-T50) (via D64.-), T37 — Poisoning by, adverse effect of and underdosing of other systemic anti-infectives and antiparasitics (via D64.-), T38 — Poisoning by, adverse effect of and underdosing of hormones and their synthetic substitutes and antagonists, not elsewhere classified (via D64.-), T39 — Poisoning by, adverse effect of and underdosing of nonopioid analgesics, antipyretics and antirheumatics (via D64.-), T40 — Poisoning by, adverse effect of and underdosing of narcotics and psychodysleptics [hallucinogens] (via D64.-), T40-T41 — Analgesics & Antipyretics (T40-T41) (via D64.-), T41 — Poisoning by, adverse effect of and underdosing of anesthetics and therapeutic gases (via D64.-), T42 — Poisoning by, adverse effect of and underdosing of antiepileptic, sedative- hypnotic and antiparkinsonism drugs (via D64.-), T42-T43 — Anticonvulsants & Psychotropics (T42-T43) (via D64.-), T43 — Poisoning by, adverse effect of and underdosing of psychotropic drugs, not elsewhere classified (via D64.-), T44 — Poisoning by, adverse effect of and underdosing of drugs primarily affecting the autonomic nervous system (via D64.-), T44-T46 — Cardiovascular & Gastrointestinal (T44-T46) (via D64.-), T45 — Poisoning by, adverse effect of and underdosing of primarily systemic and hematological agents, not elsewhere classified (via D64.-), T46 — Poisoning by, adverse effect of and underdosing of agents primarily affecting the cardiovascular system (via D64.-), T47 — Poisoning by, adverse effect of and underdosing of agents primarily affecting the gastrointestinal system (via D64.-), T47-T50 — Hormones & Systemic Agents (T47-T50) (via D64.-), +3 more.

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

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 2 MS-DRGs: DRG 811 (MDC 16), DRG 812 (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):BLD003 — Aplastic anemia (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 (Acquired Hemolytic, Aplastic, and Sideroblastic Anemias) for risk-adjusted payment.

D60.9 — Acquired pure red cell aplasia, unspecified, D61.01 — Constitutional (pure) red blood cell aplasia, D61.02 — Shwachman-Diamond syndrome, D61.03 — Fanconi anemia, D61.09 — Other constitutional aplastic anemia, D61.2 — Aplastic anemia due to other external agents, D61.3 — Idiopathic aplastic anemia, D61.818 — Other pancytopenia, D61.82 — Myelophthisis, D61.89 — Other specified aplastic anemias and other bone marrow failure syndromes, D64.0 — Hereditary sideroblastic anemia, D64.1 — Secondary sideroblastic anemia due to disease, D64.4 — Congenital dyserythropoietic anemia, P55.0 — Rh isoimmunization of newborn, P55.1 — ABO isoimmunization of newborn, P55.8 — Other hemolytic diseases of newborn, P55.9 — Hemolytic disease of newborn, unspecified, P56.0 — Hydrops fetalis due to isoimmunization, P56.90 — Hydrops fetalis due to unspecified hemolytic disease, P56.99 — Hydrops fetalis due to other hemolytic disease, +16 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Aplastic anemia).

D61.09 — Other constitutional aplastic anemia, D61.1 — Drug-induced aplastic anemia, D61.2 — Aplastic anemia due to other external agents, D61.3 — Idiopathic aplastic anemia, D61.810 — Antineoplastic chemotherapy induced pancytopenia, D61.811 — Other drug-induced pancytopenia, D61.818 — Other pancytopenia, D61.82 — Myelophthisis, D61.89 — Other specified aplastic anemias and other bone marrow failure syndromes, D61.9 — Aplastic anemia, unspecified, D63.0 — Anemia in neoplastic disease, D63.1 — Anemia in chronic kidney disease, D63.8 — Anemia in other chronic diseases classified elsewhere, D64.0 — Hereditary sideroblastic anemia, D64.1 — Secondary sideroblastic anemia due to disease, D64.2 — Secondary sideroblastic anemia due to drugs and toxins, D64.4 — Congenital dyserythropoietic anemia, D64.81 — Anemia due to antineoplastic chemotherapy, D64.89 — Other specified anemias, D64.9 — Anemia, unspecified, +7 more

Same Index main term, other category

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

D61.1 — Drug-induced aplastic anemia (aplastic, drug-induced), D61.2 — Aplastic anemia due to other external agents (toxic), D61.3 — Idiopathic aplastic anemia (aplastic, idiopathic), D61.82 — Myelophthisis (myelophthisic), D61.89 — Other specified aplastic anemias and other bone marrow failure syndromes (semiplastic), D61.9 — Aplastic anemia, unspecified (aplastic), D62 — Acute posthemorrhagic anemia (blood loss, acute), D63.0 — Anemia in neoplastic disease (in, neoplastic disease), D63.1 — Anemia in chronic kidney disease (in, failure, kidney), D63.8 — Anemia in other chronic diseases classified elsewhere (intertropical), D75.81 — Myelofibrosis (myelofibrosis), E03.9 — Hypothyroidism, unspecified (due to, myxedema), I67.89 — Other cerebrovascular disease (cerebral), O90.81 — Anemia of the puerperium (postpartum), P55.0 — Rh isoimmunization of newborn (newborn, due to, Rh), P55.1 — ABO isoimmunization of newborn (newborn, due to, ABO), P55.9 — Hemolytic disease of newborn, unspecified (erythroblastic, newborn), P61.2 — Anemia of prematurity (of prematurity), P61.3 — Congenital anemia from fetal blood loss (due to, fetal blood loss), P61.4 — Other congenital anemias, not elsewhere classified (newborn), +67 more

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.

Alpha-Fetoprotein (AFP) Test, Fecal Occult Blood Test (FOBT), Iron Panel, Prothrombin Time Test and INR (PT/INR)

Contextual Map

Every relationship of D64.3 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 D64.3 with these 11 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Code First instructions (23)

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 109 — Acquired Hemolytic, Aplastic, and Sideroblastic Anemias [CMS-HCC]— 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

  • Anemia (essential) (general) (hemoglobin deficiency) (infantile) (primary) (profound), hypochromic (idiopathic) (microcytic) (normoblastic), pyridoxine-responsive[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Anemia (essential) (general) (hemoglobin deficiency) (infantile) (primary) (profound), pyridoxine-responsive[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Anemia (essential) (general) (hemoglobin deficiency) (infantile) (primary) (profound), sideroblastic[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Anemia (essential) (general) (hemoglobin deficiency) (infantile) (primary) (profound), sideroblastic, pyridoxine-responsive NEC[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Anemia (essential) (general) (hemoglobin deficiency) (infantile) (primary) (profound), sideroblastic, specified type NEC[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Anemia (essential) (general) (hemoglobin deficiency) (infantile) (primary) (profound), vitamin, B6-responsive[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (9)

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
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section 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. "D64.3 — Other sideroblastic anemias." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/d64.3-other-sideroblastic-anemias

Change history

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

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 D64.3 in its code family, with their registry titles.

View all codes in the D64 family