D59.12
BillableCold autoimmune hemolytic anemia
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D59.12 an HCC code?
Yes. D59.12 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 D59.12
For D59.12 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 D59.12 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D59.12 is the ICD-10-CM diagnosis code for cold autoimmune hemolytic anemia. Anemia caused by antibodies that attack red blood cells primarily in cold temperatures, causing them to clump and break down, often triggered by cold exposure. D59.12 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, D59.12 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, D59.12 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.
Document temperature-related triggers and patient's response to cold exposure. Because D59.12 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 D59.12 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document temperature-related triggers and patient's response to cold exposure
- •Note if associated with infections like mycoplasma or Epstein-Barr virus
Clinical Significance
Cold autoimmune hemolytic anemia (cold agglutinin disease) is caused by immunoglobulin M autoantibodies that bind to red blood cells at temperatures below body temperature, typically at 0-4 degrees Celsius, activating the complement cascade and causing intravascular and extravascular hemolysis. Symptoms worsen with cold exposure and may include acrocyanosis (blue discoloration of extremities), Raynaud-like phenomena, and hemoglobinuria. Primary cold agglutinin disease is a clonal B-cell lymphoproliferative disorder, while secondary forms occur with infections (Mycoplasma pneumoniae, Epstein-Barr virus) or lymphomas.
Documentation Requirements
- ✓Document elevated cold agglutinin titers and positive direct antiglobulin test showing complement (C3d) coating.
- ✓Record hemoglobin levels, hemolysis markers, and any evidence of complement activation.
- ✓Document whether the condition is primary (clonal) or secondary to infection or lymphoproliferative disease.
- ✓Include cold exposure triggers, presence of acrocyanosis or Raynaud phenomena, and treatment with cold avoidance, rituximab, or complement inhibitors.
- ✓Code any underlying associated condition separately.