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ICD-10 Guide
ICD-10 CodesD59.3

D59.3

Billable

Hemolytic-uremic syndrome

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

Code Description

ICD-10 D59.3 is a billable code used to indicate a diagnosis of hemolytic-uremic syndrome.

Key Diagnostic Point:

Hemolytic-uremic syndrome (HUS) is a serious condition characterized by a triad of symptoms: hemolytic anemia, acute renal failure, and thrombocytopenia. It often occurs following an infection, particularly with certain strains of Escherichia coli (E. coli), such as O157:H7, which produce Shiga toxin. The syndrome primarily affects children but can occur in adults as well. The hemolytic component involves the destruction of red blood cells, leading to anemia, while the uremic aspect refers to the kidney failure that results from the damage to the renal microvasculature. Thrombocytopenia, or low platelet count, contributes to the risk of bleeding. The pathophysiology of HUS involves endothelial injury, which triggers a cascade of events leading to microangiopathic hemolytic anemia and renal impairment. Diagnosis is typically confirmed through clinical evaluation, laboratory tests showing anemia, elevated creatinine levels, and low platelet counts. Management focuses on supportive care, including hydration, blood transfusions, and dialysis if necessary. Early recognition and treatment are crucial to improving outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other hemolytic anemias
  • Need for comprehensive documentation of symptoms
  • Potential overlap with other renal conditions
  • Variability in presentation and severity

Audit Risk Factors

  • Inadequate documentation of acute renal failure
  • Failure to specify the underlying cause of hemolysis
  • Misclassification of thrombocytopenia
  • Lack of laboratory results to support diagnosis

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed clinical history, laboratory results, and treatment plans.

Common Clinical Scenarios

Children presenting with diarrhea followed by signs of anemia and renal failure.

Billing Considerations

Consideration of age-related factors in symptom presentation and management.

Nephrology

Documentation Requirements

Comprehensive renal function tests, imaging studies, and treatment response documentation.

Common Clinical Scenarios

Patients with acute kidney injury following gastrointestinal infections.

Billing Considerations

Focus on renal recovery and long-term follow-up care.

Coding Guidelines

Inclusion Criteria

Use D59.3 When
  • According to ICD
  • 10 guidelines, D59
  • 3 should be used when the diagnosis of hemolytic
  • uremic syndrome is confirmed, with documentation supporting the presence of hemolytic anemia, acute renal failure, and thrombocytopenia

Exclusion Criteria

Do NOT use D59.3 When
  • Exclusion criteria include other causes of acute renal failure or hemolytic anemia

Related ICD-10 Codes

Related CPT Codes

36415CPT Code

Blood transfusion

Clinical Scenario

Used in cases of severe anemia associated with HUS.

Documentation Requirements

Document indication for transfusion and patient response.

Specialty Considerations

Pediatric considerations for transfusion thresholds.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of hemolytic-uremic syndrome, improving the accuracy of data collection and reimbursement processes. It has also enhanced the ability to track epidemiological trends related to HUS.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of hemolytic-uremic syndrome, improving the accuracy of data collection and reimbursement processes. It has also enhanced the ability to track epidemiological trends related to HUS.

Reimbursement & Billing Impact

reimbursement processes. It has also enhanced the ability to track epidemiological trends related to HUS.

Resources

Clinical References

  • •
    CDC - Hemolytic Uremic Syndrome

Coding & Billing References

  • •
    CDC - Hemolytic Uremic Syndrome

Frequently Asked Questions

What are the key symptoms of hemolytic-uremic syndrome?

The key symptoms include hemolytic anemia, acute renal failure, and thrombocytopenia, often following a gastrointestinal infection.