D59.39
BillableOther hemolytic-uremic syndrome
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D59.39 an HCC code?
Yes. D59.39 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 D59.39
For D59.39 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 D59.39 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D59.39 is the ICD-10-CM diagnosis code for other hemolytic-uremic syndrome. Hemolytic-uremic syndrome caused by factors other than infection or heredity, such as certain medications or conditions. D59.39 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, D59.39 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, D59.39 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 the specific cause of HUS when identifiable (e.g., medication, malignancy, or other trigger). Because D59.39 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 D59.39 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific cause of HUS when identifiable (e.g., medication, malignancy, or other trigger)
- •Differentiate from infection-associated and hereditary forms to ensure accurate coding
Clinical Significance
Other hemolytic-uremic syndrome captures cases of thrombotic microangiopathy with the hemolytic-uremic syndrome triad caused by factors other than infection or hereditary complement defects. Common causes include medications (calcineurin inhibitors, gemcitabine, quinine, bevacizumab), malignant hypertension, transplant-associated thrombotic microangiopathy, pregnancy-related conditions, and autoimmune diseases. Identifying the specific trigger is essential because treatment depends on removing the causative factor rather than complement inhibition or supportive care alone.
Documentation Requirements
- ✓Document the specific causative factor or trigger for hemolytic-uremic syndrome (drug, underlying condition, or exposure).
- ✓Record the triad findings with supporting laboratory values including schistocytes on peripheral smear.
- ✓Include ADAMTS13 activity level to exclude thrombotic thrombocytopenic purpura.
- ✓Document complement testing results to exclude hereditary forms.
- ✓Record treatment directed at the underlying cause and any supportive measures including dialysis or plasma exchange.
Use Additional Code
Code First
Code Also
Commonly Confused Codes
- •D59.31 (Infection-associated hemolytic-uremic syndrome) is for Shiga toxin or other infection-triggered cases.
- •D59.32 (Hereditary hemolytic-uremic syndrome) involves genetic complement defects.
- •D59.30 (Hemolytic-uremic syndrome, unspecified) should be used only when the cause truly cannot be determined.
- •M31.1 (Thrombotic thrombocytopenic purpura) shares features but has severe ADAMTS13 deficiency.