ICD-10 D59.5
Billable / Specific HCC v28: 46Paroxysmal nocturnal hemoglobinuria [Marchiafava-Micheli]
About ICD-10-CM D59.5
ICD-10-CM code D59.5 represents Paroxysmal nocturnal hemoglobinuria [Marchiafava-Micheli]. This is a billable/specific code in the Blood and Blood-forming Organs chapter (block D59). The 2026 edition of ICD-10-CM D59.5 became effective on October 1, 2025.
Coding Tips for D59.5
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
D59.5 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.
Type 1 Excludes
Pure excludes, these codes can never be coded together with D59.5. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- hemoglobinuria NOS (R82.3)
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.
Medicare LCD Coverage for D59.5
Local Coverage Determinations (LCDs) from CMS MACs that list D59.5 as a covered diagnosis.
Showing top 10 of 44 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing D59.5.
1 Cigna
4 Medicare
3 Aetna
CPT Codes Commonly Billed with D59.5
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
Convert D59.5 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 |
|---|---|---|
| D59.5 | 2832 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To D59.5
Other codes in section D55-D59 (Hemolytic anemias).
ICD-10 D59.5, Billing FAQ
Is ICD-10 code D59.5 billable? +
Yes, D59.5 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 1 Excludes for D59.5? +
Type 1 Excludes (never code together with D59.5): hemoglobinuria NOS (R82.3)
Does D59.5 affect Medicare Advantage HCC risk adjustment? +
Yes. D59.5 maps to CMS-HCC v28 category 46. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with D59.5? +
Procedures frequently paired with D59.5 include: Q5152, Q5151, J1299.
What ICD-9 codes does D59.5 map to? +
Per CMS GEMs, D59.5 maps to ICD-9 codes: 2832. 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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