What is ICD-10 code D55.3?

D55.3 is the ICD-10-CM diagnosis code for Anemia due to disorders of nucleotide metabolism. A type of anemia caused by problems with nucleotide metabolism, which affects the ability of red blood cells to function properly. This leads to reduced red blood cell survival and anemia. D55.3 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. D55.3 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. D55.3 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. D55.3 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does D55.3 map to under V28?

D55.3 does not map to a CMS-HCC V28 payment category. Check the current CMS-HCC V28 model file for payment year 2026 rather than an older V24 tip sheet.

What does D55.3 pay in RAF?

D55.3 has no separately stated V28 community RAF weight. If it is not a V28 payment HCC, it adds nothing to a community RAF score.

What is the V28 vs V24 difference for D55.3?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. D55.3 was a payment HCC under V24 (Coagulation Defects and Other Specified Hematological Disorders) but the V28 recalibration removed it from the risk adjustment model. Both models can still appear in legacy data and in payer-specific lookback periods.

2026 ICD-10-CM D55.3: Anemia due to disorders

D55.3 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · HCC coding software

ICD-10-CM Code View

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Code lookupD55.3Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89) / Hemolytic anemias (D55-D59)

D55.3

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Anemia due to disorders of nucleotide metabolism

A type of anemia caused by problems with nucleotide metabolism, which affects the ability of red blood cells to function properly. This leads to reduced red blood cell survival and anemia.

Buddy Insight

Anemia due to nucleotide metabolism disorders represents a rare group of hereditary hemolytic anemias where defects in purine or pyrimidine metabolism impair red blood cell function and survival.

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Mapped

HCC 48

Coagulation Defects and Other...

RAF 0.192

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

Mapped

HCC 48

Coagulation Defects and Other...

RAF 0.063

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

D55Anemia due to enzyme disorders

D55.3Anemia due to disorders of nucleotide metabolism

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for D55.3 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for D55.3 in this effective period.

Related Child Codes

Official

D55.0Anemia due to glucose-6-phosphate dehydrogenase [G6PD] deficiency

D55.1Anemia due to other disorders of glutathione metabolism

D55.2Anemia due to disorders of glycolytic enzymes

D55.8Other anemias due to enzyme disorders

D55.9Anemia due to enzyme disorder, unspecified

Includes

Official

ICD-10-CM does not list Includes notes for D55.3 in this effective period.

Excludes 1

Official

drug-induced enzyme deficiency anemia (D59.2)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for D55.3 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for D55.3 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for D55.3 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation must identify the specific nucleotide metabolism disorder when known, with supporting laboratory evidence such as enzyme activity assays, peripheral blood smear findings (particularly basophilic stippling), and markers of hemolysis.

Record hemoglobin levels, reticulocyte counts, and any complications.

Genetic testing results should be documented if available.

MEAT Support

HCC Buddy guidance

Record hemoglobin levels, reticulocyte counts, and any complications.

Genetic testing results should be documented if available.

Audit Caution

HCC Buddy guidance

This code has no V28 HCC mapping and will lose risk adjustment value in the model transition. The rarity of these conditions means documentation must be particularly thorough to justify the code. Do not use D55.3 for lead poisoning-related basophilic stippling, which is coded under T56.

Ensure the nucleotide metabolism pathway is specifically identified rather than coding to a more general enzyme disorder.

Common Mistakes

HCC Buddy guidance

D55.3 vs. D55.21 (Pyruvate kinase deficiency) -

different metabolic pathway (nucleotide vs. glycolytic). D55.3 vs. D55.0 (Glucose-6-phosphate dehydrogenase deficiency) -

different metabolic pathway (nucleotide vs. pentose phosphate). D55.3 vs. D55.8 (Other anemias due to enzyme disorders) -

use D55.3 when the nucleotide metabolism pathway is specifically identified.

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is D55.3 an HCC code?

Yes. D55.3 maps to Coagulation Defects and Other Specified Hematological Disorders under the V24 model but is not retained in V28.

Code: D55.3
Description: Anemia due to disorders of nucleotide metabolism
HCC (V28): No CMS-HCC V28 mapping
RAF: —
Billable: Yes
Payment year: 2026

HCC Category Mapping

V24HCC 48, Coagulation Defects and Other Specified Hematological Disorders

0.192

ESRDHCC 48, Coagulation Defects and Other Specified Hematological Disorders

0.063

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

Work D55.3 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for D55.3

For D55.3 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed D55.3 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

D55.3 is the ICD-10-CM diagnosis code for anemia due to disorders of nucleotide metabolism. A type of anemia caused by problems with nucleotide metabolism, which affects the ability of red blood cells to function properly. This leads to reduced red blood cell survival and anemia. D55.3 sits in the ICD-10-CM chapter for diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (d50-d89), within the section covering hemolytic anemias (d55-d59).

Under the older CMS-HCC V24 model, D55.3 maps to Coagulation Defects and Other Specified Hematological Disorders (HCC 48) with a community, non-dual, aged base RAF weight of 0.192. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.

Nucleotide metabolism disorders are rare; ensure thorough documentation supports this diagnosis. Because D55.3 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for D55.3 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Nucleotide metabolism disorders are rare; ensure thorough documentation supports this diagnosis
•Distinguish from other enzyme disorders affecting different metabolic pathways

Clinical Significance

Anemia due to nucleotide metabolism disorders represents a rare group of hereditary hemolytic anemias where defects in purine or pyrimidine metabolism impair red blood cell function and survival. The most recognized condition in this category is pyrimidine 5'-nucleotidase deficiency, which causes basophilic stippling of red blood cells and chronic hemolysis. These disorders are clinically significant due to their chronic nature and potential for complications including gallstones and iron overload.

Documentation Requirements

✓Documentation must identify the specific nucleotide metabolism disorder when known, with supporting laboratory evidence such as enzyme activity assays, peripheral blood smear findings (particularly basophilic stippling), and markers of hemolysis.
✓Record hemoglobin levels, reticulocyte counts, and any complications.
✓Genetic testing results should be documented if available.

Commonly Confused Codes

•D55.3 vs. D55.21 (Pyruvate kinase deficiency) -
•different metabolic pathway (nucleotide vs. glycolytic). D55.3 vs. D55.0 (Glucose-6-phosphate dehydrogenase deficiency) -
•different metabolic pathway (nucleotide vs. pentose phosphate). D55.3 vs. D55.8 (Other anemias due to enzyme disorders) -
•use D55.3 when the nucleotide metabolism pathway is specifically identified.