What is ICD-10 code D59.0?

D59.0 is the ICD-10-CM diagnosis code for Drug-induced autoimmune hemolytic anemia. Anemia caused by the body's immune system attacking red blood cells as a side effect of taking certain medications. D59.0 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. D59.0 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. D59.0 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. D59.0 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 D59.0 map to under V28?

D59.0 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 D59.0 pay in RAF?

D59.0 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 D59.0?

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. D59.0 was a payment HCC under V24 (Severe 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 D59.0: Drug-induced autoimmune

D59.0 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · free HCC coding tools

ICD-10-CM Code View

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Code lookupD59.0Effective 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)

D59.0

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

Drug-induced autoimmune hemolytic anemia

Anemia caused by the body's immune system attacking red blood cells as a side effect of taking certain medications.

Buddy Insight

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Mapped

HCC 46

Severe Hematological Disorders

RAF 1.372

ACA/HHS

Mapped

HCC 69

HHS-HCC 69

Varies by metal level

ESRD/PACE

Mapped

HCC 46

Severe Hematological Disorders

RAF 0.223

RXHCC

Mapped

HCC 96

Hemolytic and Aplastic Anemias

RAF 0.722

Code Book Path

Official

D59Acquired hemolytic anemia

D59.0Drug-induced autoimmune hemolytic anemia

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for D59.0 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for D59.0 in this effective period.

Related Child Codes

Official

D59.1Other autoimmune hemolytic anemias

D59.2Drug-induced nonautoimmune hemolytic anemia

D59.3Hemolytic-uremic syndrome

D59.4Other nonautoimmune hemolytic anemias

D59.5Paroxysmal nocturnal hemoglobinuria [Marchiafava-Micheli]

Includes

Official

ICD-10-CM does not list Includes notes for D59.0 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for D59.0 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for D59.0 in this effective period.

Use Additional

Official

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

Code Also

Official

ICD-10-CM does not list Code Also instructions for D59.0 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Document the specific causative medication by name with temporal relationship between drug exposure and symptom onset.

Record a positive direct antiglobulin (Coombs) test result differentiating autoimmune from non-autoimmune mechanisms.

Include hemoglobin values, reticulocyte count, hemolysis markers, and any transfusion requirements.

Use additional external cause codes (T36-T50) to identify the responsible drug.

MEAT Support

HCC Buddy guidance

Document the specific causative medication by name with temporal relationship between drug exposure and symptom onset.

Record a positive direct antiglobulin (Coombs) test result differentiating autoimmune from non-autoimmune mechanisms.

Include hemoglobin values, reticulocyte count, hemolysis markers, and any transfusion requirements.

Use additional external cause codes (T36-T50) to identify the responsible drug.

Audit Caution

HCC Buddy guidance

Always assign the external cause code for the responsible drug -

D59.0 alone is incomplete without identifying the causative agent. Distinguish drug-induced autoimmune (positive Coombs) from drug-induced nonautoimmune (negative Coombs) hemolysis, as the codes are different. Do not assign this code for hemolytic transfusion reactions, which have their own code category. Verify the temporal relationship between drug exposure and hemolysis onset.

Common Mistakes

HCC Buddy guidance

D59.2 (Drug-induced nonautoimmune hemolytic anemia) involves direct toxic damage to red blood cells without immune mediation -

differentiate by Coombs test results. D59.10-D59.19 (Autoimmune hemolytic anemia subtypes) are used when hemolysis is autoimmune but NOT drug-induced. D59.4 (Other nonautoimmune hemolytic anemias) covers non-immune, non-drug causes. D62 (Acute posthemorrhagic anemia) represents blood loss, not hemolysis.

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 D59.0 an HCC code?

Yes. D59.0 maps to Severe Hematological Disorders under the V24 model but is not retained in V28.

Code: D59.0
Description: Drug-induced autoimmune hemolytic anemia
HCC (V28): No CMS-HCC V28 mapping
RAF: —
Billable: Yes
Payment year: 2026

HCC Category Mapping

V24HCC 46, Severe Hematological Disorders

1.372

ESRDHCC 46, Severe Hematological Disorders

0.223

RxHCCHCC 96, Hemolytic and Aplastic Anemias

0.722

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 D59.0 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for D59.0

For D59.0 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 D59.0 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

D59.0 is the ICD-10-CM diagnosis code for drug-induced autoimmune hemolytic anemia. Anemia caused by the body's immune system attacking red blood cells as a side effect of taking certain medications. D59.0 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, D59.0 maps to Severe Hematological Disorders (HCC 46) with a community, non-dual, aged base RAF weight of 1.372. 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.

Always code the causative drug using an external cause code (T36-T50 series). Because D59.0 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 D59.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Always code the causative drug using an external cause code (T36-T50 series)
•Document the specific medication name and when the reaction began

Clinical Significance

Drug-induced autoimmune hemolytic anemia occurs when a medication triggers the immune system to produce antibodies that attack the patient's own red blood cells, causing accelerated hemolysis and anemia. Common causative drugs include methyldopa, penicillins, cephalosporins, quinidine, and nonsteroidal anti-inflammatory drugs. The mechanism may involve drug adsorption onto red blood cells, immune complex formation, or true autoantibody induction, and management centers on discontinuing the offending agent alongside supportive care.

Documentation Requirements

✓Document the specific causative medication by name with temporal relationship between drug exposure and symptom onset.
✓Record a positive direct antiglobulin (Coombs) test result differentiating autoimmune from non-autoimmune mechanisms.
✓Include hemoglobin values, reticulocyte count, hemolysis markers, and any transfusion requirements.
✓Use additional external cause codes (T36-T50) to identify the responsible drug.
✓Document resolution after drug discontinuation.

Use Additional Code

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

Commonly Confused Codes

•D59.2 (Drug-induced nonautoimmune hemolytic anemia) involves direct toxic damage to red blood cells without immune mediation -
•differentiate by Coombs test results. D59.10-D59.19 (Autoimmune hemolytic anemia subtypes) are used when hemolysis is autoimmune but NOT drug-induced. D59.4 (Other nonautoimmune hemolytic anemias) covers non-immune, non-drug causes. D62 (Acute posthemorrhagic anemia) represents blood loss, not hemolysis.