D59.4 ICD-10-CM Code: Other nonautoimmune hemolytic anemias
D59.4 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 · HCC Buddy coding tools
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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)
D59.4
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther nonautoimmune hemolytic anemias
Anemia caused by the destruction of red blood cells through mechanisms that do not involve the immune system or drugs.
Buddy Insight
Other nonautoimmune hemolytic anemias encompasses acquired hemolytic anemias caused by non-immune mechanisms other than drugs, including mechanical hemolysis from prosthetic heart valves (march hemoglobinuria), microangiopathic hemolytic anemia from disseminated intravascular coagulation or malignant hypertension, thermal injury to red blood cells, and hemolysis from hypotonic solutions or osmotic stress.
CMS-HCC V28
MappedHCC 109
Coefficient HCC 109: 1.144 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 069
Code-level coefficient reference
ESRD/PACE
MappedHCC 46
Code-level coefficient reference
RXHCC
MappedHCC 96
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- Mechanical hemolytic anemia
- Microangiopathic hemolytic anemia
- Toxic hemolytic anemia
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
Includes
OfficialNo Includes notes are included in this display for D59.4. Check the code and parent instructions in the Code Book.
Excludes 1
OfficialNo Excludes 1 notes are included in this display for D59.4. Check the code and parent instructions in the Code Book.
Code First
OfficialNo Code First sequencing instructions are included in this display for D59.4. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for D59.4. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for D59.4. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 D59.4 an HCC code?
Yes. D59.4 (Other nonautoimmune hemolytic anemias) 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: D59.4 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
- D59.4
- Description
- Other nonautoimmune hemolytic anemias
- HCC (V28)
- HCC 109 — Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
- RAF reference coefficient
- 1.144
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 D59.4 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for D59.4
For D59.4, 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
D59.4 is the ICD-10-CM diagnosis code for other nonautoimmune hemolytic anemias. Anemia caused by the destruction of red blood cells through mechanisms that do not involve the immune system or drugs. D59.4 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, D59.4 maps to Acquired Hemolytic, Aplastic, and Sideroblastic Anemias (HCC 109) with a source-labeled community, non-dual, aged reference coefficient of 1.144. No V24 mapping is shown for D59.4; use the applicable model and payment year when reviewing the V28 mapping. 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.
Ensure the hemolytic anemia is not autoimmune (D59.0-D59.1) or drug-induced (D59.2) before assigning this code. For D59.4, 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 D59.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Other nonautoimmune hemolytic anemias encompasses acquired hemolytic anemias caused by non-immune mechanisms other than drugs, including mechanical hemolysis from prosthetic heart valves (march hemoglobinuria), microangiopathic hemolytic anemia from disseminated intravascular coagulation or malignant hypertension, thermal injury to red blood cells, and hemolysis from hypotonic solutions or osmotic stress. The direct antiglobulin (Coombs) test is negative, distinguishing these from autoimmune causes. Treatment targets the underlying mechanical, thermal, or chemical cause.
Documentation Requirements
- ✓Document the specific mechanism of hemolysis (mechanical, thermal, chemical, osmotic).
- ✓Record the negative direct antiglobulin test excluding autoimmune etiology.
- ✓Include hemoglobin values, peripheral blood smear findings (schistocytes for mechanical hemolysis), and hemolysis markers.
- ✓Document the underlying cause such as prosthetic valve dysfunction, disseminated intravascular coagulation, or other triggering condition.
- ✓Record treatment directed at the underlying cause.
Commonly Confused Codes
- •D59.0 (Drug-induced autoimmune hemolytic anemia) and D59.2 (Drug-induced nonautoimmune hemolytic anemia) are used when drugs are the cause.
- •D59.10-D59.19 (Autoimmune hemolytic anemias) have positive Coombs tests.
- •D59.30-D59.39 (Hemolytic-uremic syndrome) are specific thrombotic microangiopathy codes.
- •D65 (Disseminated intravascular coagulation) should be coded separately when it is the cause of microangiopathic hemolysis.