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ICD-10 Guide
ICD-10 CodesD58.9

D58.9

Billable

Hereditary hemolytic anemia, unspecified

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 D58.9 is a billable code used to indicate a diagnosis of hereditary hemolytic anemia, unspecified.

Key Diagnostic Point:

Hereditary hemolytic anemia refers to a group of inherited disorders characterized by the premature destruction of red blood cells (RBCs), leading to anemia. This condition can arise from various genetic factors, including enzyme deficiencies, membrane defects, and hemoglobinopathies. Enzyme deficiencies such as glucose-6-phosphate dehydrogenase (G6PD) deficiency can lead to hemolysis under oxidative stress. Thalassemias, which are genetic disorders affecting hemoglobin production, can also cause chronic hemolytic anemia. Sickle cell disease, another hereditary condition, results in the production of abnormal hemoglobin (HbS), leading to sickling of RBCs and subsequent hemolysis. The unspecified nature of this code indicates that the specific type of hereditary hemolytic anemia has not been determined or documented. Clinicians must conduct thorough evaluations, including family history, laboratory tests, and possibly genetic testing, to identify the underlying cause of hemolysis and guide appropriate management. Treatment may involve supportive care, blood transfusions, or more advanced therapies depending on the severity and specific type of anemia.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of hereditary conditions leading to hemolytic anemia
  • Need for precise documentation of genetic factors
  • Differentiation from acquired hemolytic anemias
  • Potential overlap with other hematological disorders

Audit Risk Factors

  • Insufficient documentation of family history
  • Lack of specific laboratory results
  • Failure to differentiate from acquired hemolytic anemia
  • Inadequate justification for the unspecified code

Specialty Focus

Medical Specialties

Hematology

Documentation Requirements

Detailed family history, laboratory results, and genetic testing outcomes.

Common Clinical Scenarios

Patients presenting with fatigue, pallor, jaundice, or splenomegaly due to hemolytic anemia.

Billing Considerations

Accurate coding requires clear documentation of the specific type of hemolytic anemia when known.

Genetics

Documentation Requirements

Genetic testing results and family pedigree charts.

Common Clinical Scenarios

Patients with a family history of hemolytic anemia seeking genetic counseling.

Billing Considerations

Documentation must include genetic findings to support the diagnosis.

Coding Guidelines

Inclusion Criteria

Use D58.9 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used when the specific type of hereditary hemolytic anemia is not documented
  • Review inclusion criteria for hereditary conditions and ensure that acquired causes are ruled out

Exclusion Criteria

Do NOT use D58.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

85025CPT Code

Complete blood count (CBC) with differential

Clinical Scenario

Used to evaluate anemia in patients suspected of having hemolytic anemia.

Documentation Requirements

Document the reason for the CBC and any abnormal findings.

Specialty Considerations

Hematologists may require additional tests based on CBC results.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of hereditary conditions, improving the ability to track and manage these disorders. D58.9 serves as a catch-all for unspecified cases, but coders should strive for specificity when possible.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of hereditary conditions, improving the ability to track and manage these disorders. D58.9 serves as a catch-all for unspecified cases, but coders should strive for specificity when possible.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of hereditary conditions, improving the ability to track and manage these disorders. D58.9 serves as a catch-all for unspecified cases, but coders should strive for specificity when possible.

Resources

Clinical References

  • •
    National Heart, Lung, and Blood Institute

Coding & Billing References

  • •
    National Heart, Lung, and Blood Institute

Frequently Asked Questions

What should I document to support the use of D58.9?

Document the patient's clinical presentation, family history of hemolytic anemia, laboratory findings, and any genetic testing results. Ensure that the documentation clearly indicates that the specific type of hereditary hemolytic anemia is unspecified.