D55-D59 — Hemolytic anemias
ICD-10-CM codes D55-D59 cover hemolytic anemias, within diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism. The block holds 96 codes across 5 categories, of which 79 are billable and 17 are header codes that cannot be submitted on a claim.
Risk adjustment in D55-D59
0 codes in this block map to a CMS-HCC, which means the diagnosis carries a risk-adjustment payment when it is documented and coded. Under-coding here is money left on the table; over-coding here is what audits are for.
- HCC 108 Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major
- HCC 107 Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero
- HCC 109 Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
What else to watch in D55-D59
- 79 codes are named in Medicare coverage policies. An LCD or NCD lists them as supporting medical necessity, or explicitly as not supporting it. Which applies depends on the MAC for your state.