ICD-10 D59.31
Billable / Specific HCC v28: 46 MCCInfection-associated hemolytic-uremic syndrome
About ICD-10-CM D59.31
ICD-10-CM code D59.31 represents Infection-associated hemolytic-uremic syndrome. This is a billable/specific code in the Blood and Blood-forming Organs chapter (block D59). The 2026 edition of ICD-10-CM D59.31 became effective on October 1, 2025.
Coding Tips for D59.31
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
D59.31 is a CMS-HCC v28 risk-adjustment code (category 46). 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.
D59.31 is designated MCC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-MCC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag MCC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under D59.31. Per CMS ICD-10-CM Tabular 2026.
- Shiga toxin-producing E. coli [STEC] related hemolytic uremic syndrome
- Typical hemolytic uremic syndrome
Use Additional Code
When coding D59.31, also report these additional codes when applicable.
- code to identify associated infection, such as :
- E. coli infection (B96.2-)
- Human immunodeficiency virus [HIV] disease (B20)
- Pneumococcal meningitis (G00.1)
- Pneumococcal pneumonia (J13)
- Sepsis due to Streptococcus pneumoniae (A40.3)
- Shigella dysenteriae (A03.9)
- Streptococcus pneumoniae as the cause of diseases classified elsewhere (B95.3)
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.
Inpatient DRG Impact, MCC
codes Infection-associated hemolytic-uremic syndrome. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for D59.31
Local Coverage Determinations (LCDs) from CMS MACs that list D59.31 as a covered diagnosis.
Showing top 10 of 540 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing D59.31.
5 Medicare
1 Aetna
CPT Codes Commonly Billed with D59.31
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- Q5152 CMS LCD: Billing and Coding: Eculizumab, and Biosimilars: EPYSQLI�-eculizumab-aagh, and BKEMV�-eculizumab-aeeb CMS LCD
- Q5151 CMS LCD: Billing and Coding: Eculizumab, and Biosimilars: EPYSQLI�-eculizumab-aagh, and BKEMV�-eculizumab-aeeb CMS LCD
- J1299 CMS LCD: Billing and Coding: Eculizumab, and Biosimilars: EPYSQLI�-eculizumab-aagh, and BKEMV�-eculizumab-aeeb CMS LCD
Codes Adjacent To D59.31
Other codes in section D55-D59 (Hemolytic anemias).
ICD-10 D59.31, Billing FAQ
Is ICD-10 code D59.31 billable? +
Yes, D59.31 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 D59.31? +
ICD-10 D59.31 includes: Shiga toxin-producing E. coli [STEC] related hemolytic uremic syndrome; Typical hemolytic uremic syndrome.
Does D59.31 affect Medicare Advantage HCC risk adjustment? +
Yes. D59.31 maps to CMS-HCC v28 category 46. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is D59.31 a CC or MCC for inpatient DRG? +
Yes, this code is designated as MCC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with D59.31? +
Procedures frequently paired with D59.31 include: Q5152, Q5151, J1299.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on July 17, 2026.
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