2027 ICD-10-CM Diagnosis Code D59.11Warm autoimmune hemolytic anemia
ICD-10-CM Codes›D50–D89›D55-D59›D59
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 109
- Not Chronic
D59.11 is a billable ICD-10-CM diagnosis code for warm autoimmune hemolytic anemia. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 808 through 810. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 16 closely related codes. Coders also document this condition as primary warm-type hemolytic anemia. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Hemolytic anemia.
For Medicare Advantage risk adjustment, D59.11 maps to CMS-HCC Category 109 (Acquired Hemolytic, Aplastic, and Sideroblastic Anemias) under the V28 model, adding a risk factor of about 1.144 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
D59.11 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Primary warm-type hemolytic anemia
- Secondary warm autoimmune hemolytic anemia
- Warm autoimmune hemolytic anemia
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to D59.11: its own notes plus those printed at D59.1 and Chapter 3. A note printed at a category, block or chapter applies to every code under it.
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Warm type (primary) (secondary) (symptomatic) autoimmune hemolytic anemia
- Warm type autoimmune hemolytic disease
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- autoimmune disease (systemic) NOS (M35.9)
- certain conditions originating in the perinatal period (P00-P96)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- human immunodeficiency virus [HIV] disease (B20)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Index to Diseases and InjuriesGuidance
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Warm Antibody Autoimmune Hemolytic Anemia
the most common form of autoimmune hemolytic anemia, in which the autoantibodies react with red blood cells at temperatures greater than or equal to 37 degrees celsius.
Patient EducationClinical
Anemia
If you have anemia, your blood does not carry enough oxygen to the rest of your body. The most common cause of anemia is not having enough iron. Your body needs iron to make hemoglobin. Hemoglobin is an iron-rich protein that gives the red color to blood. It carries oxygen from the lungs to the rest of the body.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Code History & ChangesHistory
Replacement D59.11 replaces the following previously assigned code(s):
- D59.1 - Other autoimmune hemolytic anemias
Questions About D59.11Overview
What is the ICD-10 code for warm autoimmune hemolytic anemia?
The ICD-10-CM code for warm autoimmune hemolytic anemia is D59.11 (sometimes written as D5911). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is D59.11 (Other autoimmune hemolytic anemias) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report warm autoimmune hemolytic anemia on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does D59.11 group to?
When warm autoimmune hemolytic anemia is the principal diagnosis on an inpatient stay, it groups to MS-DRG 808, 809, 810, with relative weights from 1.0749 to 2.1706 depending on complications. Higher weights mean higher Medicare reimbursement.
Is D59.11 a CC or MCC?
CMS lists D59.11 as a CC (complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 16 closely related codes in its exclusion list.
What HCC is D59.11?
D59.11 (warm autoimmune hemolytic anemia) maps to CMS-HCC Category 109 (Acquired Hemolytic, Aplastic, and Sideroblastic Anemias), commonly written as HCC 109, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 46 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 96.
Does D59.11 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, D59.11 adds a risk adjustment factor of about 1.144 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.529 to 1.815 depending on the payment segment). HCC 109 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 109 category page.
