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ICD-10 Guide
ICD-10 CodesD59.11

D59.11

Billable

Warm autoimmune hemolytic anemia

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

Code Description

ICD-10 D59.11 is a billable code used to indicate a diagnosis of warm autoimmune hemolytic anemia.

Key Diagnostic Point:

Warm autoimmune hemolytic anemia (AIHA) is a type of hemolytic anemia characterized by the premature destruction of red blood cells due to the presence of autoantibodies that react at body temperature (37°C). This condition can be idiopathic or secondary to other diseases such as lymphoproliferative disorders, autoimmune diseases (like lupus), or infections. Patients typically present with symptoms of anemia, including fatigue, pallor, jaundice, and splenomegaly. Laboratory findings often reveal a positive direct Coombs test, elevated reticulocyte count, and increased levels of indirect bilirubin. The pathophysiology involves the binding of antibodies to red blood cells, leading to their destruction by macrophages in the spleen and liver. Treatment options may include corticosteroids, immunosuppressive agents, or splenectomy in severe cases. Understanding the nuances of this condition is crucial for accurate coding and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between warm and cold autoimmune hemolytic anemia
  • Identifying secondary causes of AIHA
  • Understanding laboratory findings and their implications
  • Navigating treatment options and their documentation

Audit Risk Factors

  • Inadequate documentation of the autoimmune nature of the anemia
  • Failure to document secondary causes or associated conditions
  • Misinterpretation of laboratory results
  • Lack of clarity in treatment plans

Specialty Focus

Medical Specialties

Hematology

Documentation Requirements

Detailed lab results, treatment plans, and follow-up notes are essential.

Common Clinical Scenarios

Diagnosis and management of AIHA, monitoring response to treatment.

Billing Considerations

Ensure that all autoimmune tests and their results are documented clearly.

Rheumatology

Documentation Requirements

Documentation of underlying autoimmune conditions and their management.

Common Clinical Scenarios

Patients with AIHA secondary to lupus or other autoimmune disorders.

Billing Considerations

Document the relationship between the autoimmune disorder and hemolytic anemia.

Coding Guidelines

Inclusion Criteria

Use D59.11 When
  • According to ICD
  • 10 guidelines, D59
  • 11 should be used when the hemolytic anemia is confirmed to be autoimmune and warm in nature
  • It is important to document any underlying conditions that may contribute to the diagnosis

Exclusion Criteria

Do NOT use D59.11 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

85025CPT Code

Complete blood count (CBC) with reticulocyte count

Clinical Scenario

Used to evaluate anemia and monitor treatment response.

Documentation Requirements

Document the reason for the CBC and reticulocyte count.

Specialty Considerations

Hematologists should ensure all relevant lab results are included.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of autoimmune hemolytic anemias, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of autoimmune hemolytic anemias, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    American Society of Hematology

Coding & Billing References

  • •
    American Society of Hematology

Frequently Asked Questions

What is the primary cause of warm autoimmune hemolytic anemia?

The primary cause is the production of autoantibodies that target red blood cells, leading to their destruction. This can be idiopathic or secondary to other conditions.