D46.4 Refractory anemia, unspecified

Billable ICD-10-CM code, FY2026.

Applies from D46 Myelodysplastic syndromes

Excludes2 (not included here)

• drug-induced aplastic anemia (D61.1)

Use additional code

• code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

Risk adjustment (HCC)

• CMS-HCC V28: HCC 19 — Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers
• CMS-HCC V22: HCC 46 — Severe Hematological Disorders
• RxHCC V08: HCC 19 — Leukemias and Other Hematologic Cancers
• ESRD V24: HCC 46

MS-DRG index

Defines the logic of DRG(s) 811-812 in MDC 16.

Approximate ICD-9-CM (GEMs)

• 238.72 Low grade myelodysplastic syndrome lesions (approximate)

Code annotations containing back-references to D46.4

Back-references to D46

• Type 1 Excludes: C94 Other leukemias of specified cell type ("myelodysplastic syndromes (D46.-)")
• Code Also: D61.02 Shwachman-Diamond syndrome ("myelodysplastic syndrome (D46.-)")
• Type 2 Excludes: D61.81 Pancytopenia ("pancytopenia (due to) (with) myelodysplastic syndromes (D46.-)")
• Type 1 Excludes: D64 Other anemias ("refractory anemia (D46.-)")
• Use Additional: D75.81 Myelofibrosis ("code, if applicable, for associated therapy-related myelodysplastic syndrome (D46.-)")

Diagnosis Index entries for D46.4

• Anemia (essential) (general) (hemoglobin deficiency) (infantile) (primary) (profound) › refractory

Nearby codes

• D46.21 Refractory anemia with excess of blasts 1
• D46.22 Refractory anemia with excess of blasts 2
• 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
• D46.4 Refractory anemia, unspecified (this code)
• D46.Z Other myelodysplastic syndromes
• D46.9 Myelodysplastic syndrome, unspecified