ICD-10 D55.21
Billable / Specific HCC v28: 48Anemia due to pyruvate kinase deficiency
About ICD-10-CM D55.21
ICD-10-CM code D55.21 represents Anemia due to pyruvate kinase deficiency. This is a billable/specific code in the Blood and Blood-forming Organs chapter (block D55). The 2026 edition of ICD-10-CM D55.21 became effective on October 1, 2025.
Coding Tips for D55.21
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
D55.21 is a CMS-HCC v28 risk-adjustment code (category 48). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under D55.21. Per CMS ICD-10-CM Tabular 2026.
- PK deficiency anemia
- Pyruvate kinase deficiency anemia
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Medicare LCD Coverage for D55.21
Local Coverage Determinations (LCDs) from CMS MACs that list D55.21 as a covered diagnosis.
Showing top 10 of 13 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing D55.21.
1 Medicare
1 Aetna
Codes Adjacent To D55.21
Other codes in section D55-D59 (Hemolytic anemias).
ICD-10 D55.21, Billing FAQ
Is ICD-10 code D55.21 billable? +
Yes, D55.21 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to D55.21? +
ICD-10 D55.21 includes: PK deficiency anemia; Pyruvate kinase deficiency anemia.
Does D55.21 affect Medicare Advantage HCC risk adjustment? +
Yes. D55.21 maps to CMS-HCC v28 category 48. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with D55.21? +
Procedures frequently paired with D55.21 include: J2791, J2792.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on July 16, 2026.
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