ICD-10-CM 2027
ICD-10 code for refractory anemia
From the official ICD-10-CM alphabetic index entry “Anemia (essential) (general) (hemoglobin deficiency) (infantile) (primary) (profound) › refractory”. Page updated September 29, 2026.
About coding refractory anemia
The ICD-10-CM code for refractory anemia is D46.4 (Refractory anemia, unspecified). The official index lists 10 more specific codes, so check the documentation for details such as type, cause, site or severity before settling on D46.4.
Within D46, choose D46.4 (Refractory anemia, unspecified) only when documentation doesn't support a more specific option: refractory anemia without ring sideroblasts, so stated (D46.0), refractory anemia with ring sideroblasts (D46.1), refractory anemia with excess of blasts [RAEB] (D46.2), myelodysplastic syndrome, unspecified (D46.9), refractory cytopenia with multilineage dysplasia (D46.A), refractory cytopenia with multilineage dysplasia and ring sideroblasts (D46.B), myelodysplastic syndrome with isolated del(5q) chromosomal abnormality (D46.C) and other myelodysplastic syndromes (D46.Z).
Use an additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5).
It is not a CC or MCC, so as a secondary diagnosis it doesn't change the MS-DRG severity level.
More specific refractory anemia codes (official index)
- with
- excess of blasts D46.20 — Refractory anemia with excess of blasts, unspecified
- 1 (RAEB 1) D46.21 — Refractory anemia with excess of blasts 1
- 2 (RAEB 2) D46.22 — Refractory anemia with excess of blasts 2
- in transformation (RAEB T)
- hemochromatosis D46.1 — Refractory anemia with ring sideroblasts
- sideroblasts (ring) (RARS) D46.1 — Refractory anemia with ring sideroblasts
- megaloblastic D53.1 — Other megaloblastic anemias, not elsewhere classified
- sideroblastic D46.1 — Refractory anemia with ring sideroblasts
- sideropenic D50.9 — Iron deficiency anemia, unspecified
- without ring sideroblasts, so stated D46.0 — Refractory anemia without ring sideroblasts, so stated
- without sideroblasts without excess of blasts D46.0 — Refractory anemia without ring sideroblasts, so stated
Common questions about refractory anemia ICD-10 codes
What is the ICD-10 code for refractory anemia?
- D46.4 — Refractory anemia, unspecified. More specific codes apply when the documentation supports them: D46.20, D46.21, D46.22, D46.1 and others below.
What is the ICD-10 code for megaloblastic refractory anemia?
- D53.1 — Other megaloblastic anemias, not elsewhere classified.
What is the ICD-10 code for sideroblastic refractory anemia?
- D46.1 — Refractory anemia with ring sideroblasts.
What is the ICD-10 code for sideropenic refractory anemia?
- D50.9 — Iron deficiency anemia, unspecified.
Is D46.4 billable?
- Yes. D46.4 is a billable/specific ICD-10-CM code valid for FY2027 (October 1, 2026 – September 30, 2027).
Can D46.4 be used as a principal diagnosis?
- Yes. The Medicare Code Editor doesn't restrict D46.4 as a principal diagnosis.
Is D46.4 a CC or MCC?
- No. D46.4 is neither a CC nor an MCC under MS-DRG v44.0.