ICD-10 D55.9
Billable / Specific HCC v28: 48Anemia due to enzyme disorder, unspecified
About ICD-10-CM D55.9
ICD-10-CM code D55.9 represents Anemia due to enzyme disorder, unspecified. This is a billable/specific code in the Blood and Blood-forming Organs chapter (block D55). The 2026 edition of ICD-10-CM D55.9 became effective on October 1, 2025.
Coding Tips for D55.9
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
D55.9 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.
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 D55.9
Local Coverage Determinations (LCDs) from CMS MACs that list D55.9 as a covered diagnosis.
Showing top 10 of 153 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing D55.9.
5 Medicare
Convert D55.9 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| D55.9 | 2823 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To D55.9
Other codes in section D55-D59 (Hemolytic anemias).
ICD-10 D55.9, Billing FAQ
Is ICD-10 code D55.9 billable? +
Yes, D55.9 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does D55.9 affect Medicare Advantage HCC risk adjustment? +
Yes. D55.9 maps to CMS-HCC v28 category 48. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with D55.9? +
Procedures frequently paired with D55.9 include: J2791, J2792.
What ICD-9 codes does D55.9 map to? +
Per CMS GEMs, D55.9 maps to ICD-9 codes: 2823. Useful for legacy data review and historical claim analysis.
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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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