2027 ICD-10-CM Diagnosis Code D59.5Paroxysmal nocturnal hemoglobinuria [Marchiafava-Micheli]
ICD-10-CM Codes›D50–D89›D55-D59›D59
- Billable — Valid for Submission
- Risk Adjusts — HCC 109
- Chronic Condition
D59.5 is a billable ICD-10-CM diagnosis code for paroxysmal nocturnal hemoglobinuria [Marchiafava-Micheli]. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 791, 793, 808 through 810. Coders also document this condition as occlusion of microvasculature of skin caused by platelet plug. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Hemolytic anemia.
For Medicare Advantage risk adjustment, D59.5 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
D59.5 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.
- Occlusion of microvasculature of skin caused by platelet plug
- Occlusion of microvasculature of skin due to platelet thrombus associated with paroxysmal nocturnal hemoglobinuria
- Paroxysmal nocturnal hemoglobinuria
- Thrombophilia due to paroxysmal nocturnal hemoglobinuria
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to D59.5: its own notes plus those printed at Chapter 3. A note printed at a category, block or chapter applies to every code under it.
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
- hemoglobinuria NOS (R82.3)
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.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name D59.5, its category, or a range that includes it.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
paroxysmal See Also: Hematuria, idiopathic;
nocturnal D59.5
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Acquired Hemolytic Anemia
hemolytic anemia, the cause of which is not present at birth.
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.
Convert D59.5 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About D59.5Overview
What is the ICD-10 code for paroxysmal nocturnal hemoglobinuria [Marchiafava-Micheli]?
The ICD-10-CM code for paroxysmal nocturnal hemoglobinuria [Marchiafava-Micheli] is D59.5 (sometimes written as D595). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is D59.5 (Acquired hemolytic anemia) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report paroxysmal nocturnal hemoglobinuria [Marchiafava-Micheli] on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does D59.5 group to?
When paroxysmal nocturnal hemoglobinuria [Marchiafava-Micheli] is the principal diagnosis on an inpatient stay, it groups to MS-DRG 793, 791, 808, 809, 810, with relative weights from 1.0749 to 4.2192 depending on complications. Higher weights mean higher Medicare reimbursement.
Can D59.5 be reported with R82.3?
Not as a rule. The Excludes1 note on D59.5 lists "hemoglobinuria NOS (R82.3)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What is the ICD-9 equivalent of D59.5?
Under the General Equivalence Mappings, paroxysmal nocturnal hemoglobinuria [Marchiafava-Micheli] converts to ICD-9-CM 283.2 (hemolytic hemoglobinuria). The mapping is approximate, so confirm the match fits the documentation.
What HCC is D59.5?
D59.5 (paroxysmal nocturnal hemoglobinuria [Marchiafava-Micheli]) 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 D59.5 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, D59.5 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.
