D59.10
BillableAutoimmune hemolytic anemia, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D59.10 an HCC code?
Yes. D59.10 maps to Hemolytic and Aplastic Anemias under the CMS-HCC V28 risk adjustment model (and Severe Hematological Disorders under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. 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.
MEAT Criteria for D59.10
For D59.10 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 D59.10 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D59.10 is the ICD-10-CM diagnosis code for autoimmune hemolytic anemia, unspecified. Anemia caused by the body's immune system mistakenly attacking and destroying its own red blood cells, but the specific type is not specified. D59.10 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 CMS-HCC V28 risk adjustment model, D59.10 maps to Hemolytic and Aplastic Anemias (HCC 109) with a community, non-dual, aged base RAF weight of 0.291. Under the older CMS-HCC V24 model, D59.10 maps to Severe Hematological Disorders (HCC 46) with a community, non-dual, aged base RAF weight of 0.666. 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.
Query provider to determine if warm or cold type is present for more specific coding. Because D59.10 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 D59.10 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Query provider to determine if warm or cold type is present for more specific coding
- •This code should be used only when the type cannot be determined
Clinical Significance
Autoimmune hemolytic anemia, unspecified indicates the body's immune system is destroying its own red blood cells through autoantibody production, but the documentation does not specify whether the antibodies are warm-reactive (immunoglobulin G-mediated) or cold-reactive (immunoglobulin M-mediated). The distinction between warm and cold types is clinically important because treatment approaches differ substantially -- warm type responds to corticosteroids and splenectomy, while cold type requires cold avoidance and rituximab.
Documentation Requirements
- ✓Document the positive direct antiglobulin (Coombs) test with antibody characterization (immunoglobulin G vs immunoglobulin M).
- ✓Record hemoglobin levels, reticulocyte count, lactate dehydrogenase, indirect bilirubin, and haptoglobin.
- ✓Note any underlying associated conditions such as systemic lupus erythematosus, lymphoproliferative disorders, or infections.
- ✓Query the provider to specify warm vs cold type based on laboratory findings.
- ✓Document treatment response to steroids or other immunosuppressive therapy.
Commonly Confused Codes
- •D59.11 (Warm autoimmune hemolytic anemia) and D59.12 (Cold autoimmune hemolytic anemia) are more specific and preferred over D59.
- •D59.0 (Drug-induced autoimmune hemolytic anemia) should be used when a causative drug is identified. D59.13 (Mixed type autoimmune hemolytic anemia) applies when both warm and cold antibodies are present. D58.0 (Hereditary spherocytosis) can mimic autoimmune hemolytic anemia on blood smear but has a negative Coombs test.