D57.02 maps to CMS-HCC V28 107. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

HCC Buddy Code Card

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Code lookupD57.02

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89) / Hemolytic anemias (D55-D59)

D57.02

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Hb-SS disease with splenic sequestration

Sickle cell disease with an acute crisis where the spleen traps and destroys red blood cells, causing severe anemia and organ dysfunction.

Buddy Insight

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 107

Sickle Cell Anemia (Hb-SS) an...

Coefficient HCC 107: 0.457 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 070

HHS-HCC 070 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 46

Severe Hematological Disorders

Code-level coefficient reference

RXHCC

Mapped

HCC 95

Sickle Cell Anemia

Code-level coefficient reference

Code Book Path

Official

D57Sickle-cell disorders D57.0Hb-SS disease with crisis D57.02Hb-SS disease with splenic sequestration

Inclusion Terms

Official

Sickle-cell disease with crisisInherited from D57.0
Hb-SS disease with (vaso-occlusive) painInherited from D57.0

Excludes 2

Official

autoimmune disease (systemic) NOS (M35.9)Inherited from D50-D89
certain conditions originating in the perinatal period (P00-P96)Inherited from D50-D89
complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from D50-D89
congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from D50-D89
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from D50-D89
human immunodeficiency virus [HIV] disease (B20)Inherited from D50-D89
injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from D50-D89
neoplasms (C00-D49)Inherited from D50-D89
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from D50-D89

Related Codes

Official

D57.00Hb-SS disease with crisis, unspecified D57.01Hb-SS disease with acute chest syndrome D57.03Hb-SS disease with cerebral vascular involvement D57.04Hb-SS disease with dactylitis D57.09Hb-SS disease with crisis with other specified complication

Includes

Official

No Includes notes are included in this display for D57.02. Check the code and parent instructions in the Code Book.

Excludes 1

Official

other hemoglobinopathies (D58.-)Inherited from D57

Code First

Official

No Code First sequencing instructions are included in this display for D57.02. Check the code and parent instructions in the Code Book.

Use Additional

Official

code for any associated fever (R50.81)Inherited from D57

Code Also

Official

No Code Also instructions are included in this display for D57.02. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Documentation must confirm Hemoglobin SS genotype and the diagnosis of splenic sequestration with evidence of acute splenomegaly, rapid hemoglobin decline (typically >2 g/dL from baseline), reticulocytosis, and clinical signs of acute anemia or hemodynamic instability.

Record physical exam findings of splenic enlargement, vital signs, laboratory values including hemoglobin drop, platelet count, and reticulocyte count.

Document treatment including transfusion volumes, and note if splenectomy is performed or recommended.

MEAT Support

HCC Buddy guidance

Record physical exam findings of splenic enlargement, vital signs, laboratory values including hemoglobin drop, platelet count, and reticulocyte count.

Document treatment including transfusion volumes, and note if splenectomy is performed or recommended.

Audit Caution

HCC Buddy guidance

This is an acute crisis code -- do not assign for chronic splenomegaly without acute sequestration. The code includes the sickle cell disease diagnosis, so do not also code D57.1 or D57.

Ensure documentation clearly states 'splenic sequestration' rather than just 'splenomegaly.' If splenectomy is performed, code the procedure separately.

Common Mistakes

HCC Buddy guidance

D57.02 vs. D57.00 (Hemoglobin SS with crisis, unspecified) -

use D57.02 when splenic sequestration is specifically documented. D57.02 vs. D73.2 (Chronic congestive splenomegaly) -

splenic sequestration is an acute crisis, not chronic congestion. D57.02 vs. D57.212 (Sickle-cell/Hemoglobin C with splenic sequestration) -

different sickle cell genotype.

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is D57.02 an HCC code?

Yes. D57.02 (Hb-SS disease with splenic sequestration) maps to HCC 107, Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.457. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: D57.02 is billable and maps to V28 HCC 107, Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: D57.02
Description: Hb-SS disease with splenic sequestration
HCC (V28): HCC 107 — Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero
RAF reference coefficient: 0.457
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 107, Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero

0.457

ESRDHCC 46, Severe Hematological Disorders

Not separately weighted

RxHCCHCC 95, Sickle Cell Anemia

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work D57.02 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for D57.02

For D57.02, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

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

Coder workflow notes

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What This Code Means

D57.02 is the ICD-10-CM diagnosis code for hb-ss disease with splenic sequestration. Sickle cell disease with an acute crisis where the spleen traps and destroys red blood cells, causing severe anemia and organ dysfunction. D57.02 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, D57.02 maps to Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero (HCC 107) with a source-labeled community, non-dual, aged reference coefficient of 0.457. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Document evidence of splenic sequestration such as splenomegaly, acute anemia, or reticulocytosis in crisis. For D57.02, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for D57.02 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document evidence of splenic sequestration such as splenomegaly, acute anemia, or reticulocytosis in crisis
•Ensure crisis status is documented; this code specifically indicates acute splenic sequestration complication

Clinical Significance

Splenic sequestration in Hemoglobin SS disease is a medical emergency where large volumes of blood become trapped in the spleen, causing rapid splenic enlargement, acute severe anemia, and potentially hypovolemic shock. It is most common in children under age 5 with Hemoglobin SS disease before autosplenectomy occurs but can also affect adults with other sickle cell genotypes. Mortality rates are high without prompt transfusion and supportive care.

Documentation Requirements

✓Documentation must confirm Hemoglobin SS genotype and the diagnosis of splenic sequestration with evidence of acute splenomegaly, rapid hemoglobin decline (typically >2 g/dL from baseline), reticulocytosis, and clinical signs of acute anemia or hemodynamic instability.
✓Record physical exam findings of splenic enlargement, vital signs, laboratory values including hemoglobin drop, platelet count, and reticulocyte count.
✓Document treatment including transfusion volumes, and note if splenectomy is performed or recommended.

Commonly Confused Codes

•D57.02 vs. D57.00 (Hemoglobin SS with crisis, unspecified) -
•use D57.02 when splenic sequestration is specifically documented. D57.02 vs. D73.2 (Chronic congestive splenomegaly) -
•splenic sequestration is an acute crisis, not chronic congestion. D57.02 vs. D57.212 (Sickle-cell/Hemoglobin C with splenic sequestration) -
•different sickle cell genotype.