What is ICD-10 code D59.12?

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 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. D59.12 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. D59.12 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. D59.12 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.

What is the V28 vs V24 difference for D59.12?

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. For D59.12, V28 maps to Acquired Hemolytic, Aplastic, and Sideroblastic Anemias at RAF 1.144 while V24 mapped to Severe Hematological Disorders at RAF 1.372. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting D59.12?

Document temperature-related triggers and patient's response to cold exposure Note if associated with infections like mycoplasma or Epstein-Barr virus Because D59.12 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

2026 ICD-10-CM D59.12: Cold autoimmune hemolytic

ICD-10-CM Code View

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Code lookupD59.12Effective 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)

D59.12

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

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.

Buddy Insight

CMS-HCC V28

Mapped

HCC 109

Acquired Hemolytic, Aplastic,...

RAF 1.144

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

D59.1Other autoimmune hemolytic anemias

D59.12Cold autoimmune hemolytic anemia

Inclusion Terms

Official

Chronic cold hemagglutinin disease
Cold agglutinin disease
Cold agglutinin hemoglobinuria
Cold type (primary) (secondary) (symptomatic) autoimmune hemolytic anemia
Cold type autoimmune hemolytic disease

Excludes 2

Official

Evans syndrome (D69.41)
hemolytic disease of newborn (P55.-)
paroxysmal cold hemoglobinuria (D59.6)

Related Child Codes

Official

D59.10Autoimmune hemolytic anemia, unspecified

D59.11Warm autoimmune hemolytic anemia

D59.13Mixed type autoimmune hemolytic anemia

D59.19Other autoimmune hemolytic anemia

Includes

Official

ICD-10-CM does not list Includes notes for D59.12 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for D59.12 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for D59.12 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for D59.12 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for D59.12 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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.

MEAT Support

HCC Buddy guidance

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.

Audit Caution

HCC Buddy guidance

Do not confuse cold agglutinin disease with cryoglobulinemia, which involves different immunoglobulin types and has distinct clinical features. Secondary cold agglutinin syndrome from acute infections (particularly Mycoplasma) is usually transient and self-limiting -

distinguish from chronic primary disease. Code the underlying lymphoproliferative disorder or infection when present as the primary diagnosis. Cold autoimmune hemolytic anemia does not respond to corticosteroids or splenectomy, unlike warm type.

Common Mistakes

HCC Buddy guidance

D59.11 (Warm autoimmune hemolytic anemia) involves immunoglobulin G antibodies active at body temperature.

D59.13 (Mixed type autoimmune hemolytic anemia) applies when both warm and cold antibodies are present.

I73.0 (Raynaud syndrome) may coexist but is a separate condition.

D47.2 (Monoclonal gammopathy) may be an underlying cause when cold agglutinin disease is clonal.

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 D59.12 an HCC code?

Yes. D59.12 (Cold autoimmune hemolytic anemia) maps to Acquired Hemolytic, Aplastic, and Sideroblastic Anemias under the CMS-HCC V28 risk adjustment model (and Severe Hematological Disorders under V24), with a community non-dual aged RAF of 1.144. It is billable for payment year 2026.

Coder answer: D59.12 is billable and maps to V28 HCC 109, Acquired Hemolytic, Aplastic, and Sideroblastic Anemias. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: D59.12
Description: Cold autoimmune hemolytic anemia
HCC (V28): HCC 109 — Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
RAF: 1.144
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 109, Acquired Hemolytic, Aplastic, and Sideroblastic Anemias

1.144

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 D59.12 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

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.

Coder workflow notes

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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 Acquired Hemolytic, Aplastic, and Sideroblastic Anemias (HCC 109) with a community, non-dual, aged base RAF weight of 1.144. 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 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.

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.

Commonly Confused Codes

•D59.11 (Warm autoimmune hemolytic anemia) involves immunoglobulin G antibodies active at body temperature.
•D59.13 (Mixed type autoimmune hemolytic anemia) applies when both warm and cold antibodies are present.
•I73.0 (Raynaud syndrome) may coexist but is a separate condition.
•D47.2 (Monoclonal gammopathy) may be an underlying cause when cold agglutinin disease is clonal.