D57.00
BillableHb-SS disease with crisis, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D57.00 an HCC code?
Yes. D57.00 maps to Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero under the CMS-HCC V28 risk adjustment model (and Severe Hematological Disorders under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for D57.00
For D57.00 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed D57.00 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D57.00 is the ICD-10-CM diagnosis code for hb-ss disease with crisis, unspecified. Sickle cell disease (the most severe form) with an acute crisis episode, but the specific type of crisis complication is not documented. D57.00 sits in the ICD-10-CM chapter for diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (d50-d89), within the section covering hemolytic anemias (d55-d59).
Under the CMS-HCC V28 risk adjustment model, D57.00 maps to Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero (HCC 107) with a community, non-dual, aged base RAF weight of 0.727. Under the older CMS-HCC V24 model, D57.00 maps to Severe Hematological Disorders (HCC 46) with a community, non-dual, aged base RAF weight of 0.666. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
This code requires a crisis; do not use if patient is in steady state without acute complications. Because D57.00 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for D57.00 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code requires a crisis; do not use if patient is in steady state without acute complications
- •Review clinical documentation to identify the specific crisis type (pain, splenic sequestration, stroke, etc.) for more precise coding
Clinical Significance
Hemoglobin SS disease (sickle cell anemia) with crisis represents the most severe and common form of sickle cell disease during an acute exacerbation. Vaso-occlusive crises cause severe pain, organ damage, and life-threatening complications. This unspecified crisis code indicates the provider documented a crisis event but did not specify the type (pain crisis, splenic sequestration, acute chest syndrome, stroke, or dactylitis), representing a documentation improvement opportunity.
Documentation Requirements
- ✓Documentation must confirm both the Hemoglobin SS genotype and an active crisis at the time of the encounter. The provider should specify the type of crisis whenever possible -
- ✓pain crisis, splenic sequestration, acute chest syndrome, cerebral vascular involvement, or dactylitis. Record pain location and severity, vital signs, laboratory findings, imaging results, treatment administered, and hospital admission if applicable. Crisis type specification allows more precise coding.
Commonly Confused Codes
- •D57.00 vs. D57.1 (Sickle-cell disease without crisis) -
- •D57.1 is for the baseline chronic condition when no acute crisis is present. D57.00 vs. D57.01-D57.09 (Hemoglobin SS with specific crisis types) -
- •query for specificity to select the appropriate crisis code. D57.00 vs. D57.219 (Sickle-cell/Hemoglobin C disease with crisis, unspecified) -
- •different sickle cell genotype.