D59.4

HCC Category Mapping

What This Code Means

Anemia caused by the destruction of red blood cells through mechanisms that do not involve the immune system or drugs.

Coding Tips

• •Ensure the hemolytic anemia is not autoimmune (D59.0-D59.1) or drug-induced (D59.2) before assigning this code
• •Document the underlying cause such as mechanical damage, toxins, or other physical factors

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