Q&A: ICD-10-CM coding for autoimmune hemolytic anemia

October 30, 2020
Medicare Web

Q: What is the difference between cold, hot, and mixed type autoimmune hemolytic anemia, as described by 2021 ICD-10-CM codes D59.11-D59.13?

A: ICD-10-CM code category D59.- (acquired hemolytic anemia) includes codes for hemolytic anemia from acquired conditions that result in the premature destruction of red blood cells, as opposed to hereditary disorders causing anemia. In autoimmune hemolytic anemia, the body destroys red blood cells more rapidly than it produces them.

The 2021 ICD-10-CM update added five new codes for autoimmune hemolytic anemia:

  • D59.10, autoimmune hemolytic anemia, unspecified
  • D59.11, warm autoimmune hemolytic anemia
  • D59.12, cold autoimmune hemolytic anemia
  • D59.13, mixed type autoimmune hemolytic anemia
  • D59.19, other autoimmune hemolytic anemia

All of these new codes are complications or comorbidities.

Warm antibody hemolytic anemia is the most common form of autoimmune hemolytic anemia. It is defined by the presence of autoantibodies that destroy red blood cells at temperatures equal to or greater than normal body temperature (37 degrees Celsius).

Affected individuals may present with abnormal paleness of the skin (pallor), fatigue, and difficulty breathing upon exertion. Other symptoms of warm antibody hemolytic anemia include yellowing of the skin and whites of the eyes (jaundice) and enlargement of the spleen (splenomegaly).

Cold antibody hemolytic anemia is a rare autoimmune disorder characterized by the premature destruction of red blood cells by autoantibodies at temperatures of approximately 0 to 10 degrees Celsius.

Normally, red blood cells have a life span of approximately 120 days before they are destroyed by the spleen. In individuals with cold antibody hemolytic anemia, the red blood cells are destroyed prematurely and production rate of new cells in the bone marrow can no longer compensate for their loss.

Patients with cold antibody hemolytic anemia  experience weakness, dizziness, fatigue, headache, ringing in the ears (tinnitus), and spots before the eyes. In some cases, affected individuals may experience sweating and coldness of the fingers and/or toes and uneven bluish or reddish discoloration of the skin of the digits, ankles, and wrists (acrocyanosis or Raynaud’s sign).

Mixed autoimmune hemolytic anemia is a type of autoimmune hemolytic anemia is defined by the presence of both warm and cold autoantibodies.

Editor’s note: This question was answered by Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O, director of HIM and coding for HCPro in Middleton, Massachusetts, during the HCPro webinar, “JustCoding's 2021 ICD-10-CM Code Updates.”

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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