D59.5

D59.5: Paroxysmal nocturnal hemoglobinuria [Marchiafava-Micheli]

Billable / specific codeICD-10-CM

D59.5 is a billable, specific ICD-10-CM code for paroxysmal nocturnal hemoglobinuria [marchiafava-micheli]. It is valid for submission on a claim.

Check D59.5 with the rest of the claim: free scrubber

Excludes1: never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

hemoglobinuria NOS (R82.3)

Other codes that can never be billed with D59.5

Their own Excludes1 notes name this code, so the conflict is not listed above.

R82.3Hemoglobinuria

Risk adjustment

D59.5 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 109 Acquired Hemolytic, Aplastic, and Sideroblastic Anemias1.144 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

D59.5 is named in 4 Medicare coverage policies: 4 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A54548Billing and Coding: Eculizumab, and Biosimilars: EPYSQLI®-eculizumab-aagh, and BKEMV™-eculizumab-aeeb
A55717Billing and Coding: Lab: Flow Cytometry
A56464Billing and Coding: Flow Cytometry
A57689Billing and Coding: Lab: Flow Cytometry

Alphabetic index entries that lead here

Marchiafava-Micheli syndrome
Hemoglobinuria›nocturnal(paroxysmal)
Hematuria›paroxysmal›nocturnal
Hemoglobinemia›paroxysmal›nocturnal
Hemoglobinuria›paroxysmal›nocturnal

Code history

Unchanged in every release from FY2024 to FY2027.