D59.39 maps to CMS-HCC V28 109. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

HCC Buddy Code Card

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Code lookupD59.39

Effective 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)

D59.39

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

Other hemolytic-uremic syndrome

Hemolytic-uremic syndrome caused by factors other than infection or heredity, such as certain medications or conditions.

Buddy Insight

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.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 109

Acquired Hemolytic, Aplastic,...

Coefficient HCC 109: 1.144 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 069

HHS-HCC 069 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 46

Severe Hematological Disorders

Code-level coefficient reference

RXHCC

Mapped

HCC 96

Acquired Hemolytic, Aplastic,...

Code-level coefficient reference

Code Book Path

Official

D59Acquired hemolytic anemia D59.3Hemolytic-uremic syndrome D59.39Other hemolytic-uremic syndrome

Inclusion Terms

Official

Atypical (nongenetic) hemolytic uremic syndrome
Secondary hemolytic-uremic syndrome

Excludes 2

Official

autoimmune disease (systemic) NOS (M35.9)Inherited from D50-D89
certain conditions originating in the perinatal period (P00-P96)Inherited from D50-D89
complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from D50-D89
congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from D50-D89
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from D50-D89
human immunodeficiency virus [HIV] disease (B20)Inherited from D50-D89
injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from D50-D89
neoplasms (C00-D49)Inherited from D50-D89
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from D50-D89

Related Codes

Official

D59.30Hemolytic-uremic syndrome, unspecified D59.31Infection-associated hemolytic-uremic syndrome D59.32Hereditary hemolytic-uremic syndrome

Includes

Official

No Includes notes are included in this display for D59.39. Check the code and parent instructions in the Code Book.

Excludes 1

Official

No Excludes 1 notes are included in this display for D59.39. Check the code and parent instructions in the Code Book.

Code First

Official

, if applicable, any associated:
COVID-19 (U07.1)
complications of kidney transplant (T86.1-)
complications of heart transplant (T86.2-)
complications of liver transplant (T86.4-)

Use Additional

Official

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

Code Also

Official

, if applicable, any associated condition, such as:
hypertensive emergency (I16.1)
malignant neoplasm (C00-C96)
systemic lupus erythematosus (M32.-)
, if applicable, any associated:Inherited from D59.3
acute kidney failure (N17.-)Inherited from D59.3
chronic kidney disease (N18.-)Inherited from D59.3

Buddy Documentation Tip

HCC Buddy guidance

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.

MEAT Support

HCC Buddy guidance

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.

Audit Caution

HCC Buddy guidance

Always identify and code the underlying cause separately (for example, the causative drug with T36-T50 codes, or the underlying malignancy). Do not use this code when infection or hereditary causes have been confirmed. ADAMTS13 testing is essential to distinguish from thrombotic thrombocytopenic purpura, as treatment approaches differ significantly. Drug-induced hemolytic-uremic syndrome may recur with re-exposure to the offending agent -

document this risk.

Common Mistakes

HCC Buddy guidance

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.

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 D59.39 an HCC code?

Yes. D59.39 (Other hemolytic-uremic syndrome) maps to HCC 109, Acquired Hemolytic, Aplastic, and Sideroblastic Anemias under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 1.144. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: D59.39 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: D59.39
Description: Other hemolytic-uremic syndrome
HCC (V28): HCC 109 — Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
RAF reference coefficient: 1.144
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 109, Acquired Hemolytic, Aplastic, and Sideroblastic Anemias

1.144

ESRDHCC 46, Severe Hematological Disorders

Not separately weighted

RxHCCHCC 96, Acquired Hemolytic, Aplastic, and Sideroblastic Anemias

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work D59.39 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for D59.39

For D59.39, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

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

Coder workflow notes

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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 Acquired Hemolytic, Aplastic, and Sideroblastic Anemias (HCC 109) with a source-labeled community, non-dual, aged reference coefficient of 1.144. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Document the specific cause of HUS when identifiable (e.g., medication, malignancy, or other trigger). For D59.39, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, 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, if applicable, for adverse effect to identify drug (T36-T50 with fifth or sixth character 5)

Code First

, if applicable, any associated:
COVID-19 (U07.1)
complications of kidney transplant (T86.1-)
complications of heart transplant (T86.2-)
complications of liver transplant (T86.4-)

Code Also

, if applicable, any associated condition, such as:
hypertensive emergency (I16.1)
malignant neoplasm (C00-C96)
systemic lupus erythematosus (M32.-)

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.