D57.02
BillableHb-SS disease with splenic sequestration
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D57.02 an HCC code?
Yes. D57.02 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 D57.02
For D57.02 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 D57.02 during that encounter — not just copy-forwarded from a problem list.
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 community, non-dual, aged base RAF weight of 0.727. Under the older CMS-HCC V24 model, D57.02 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.
Document evidence of splenic sequestration such as splenomegaly, acute anemia, or reticulocytosis in crisis. Because D57.02 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 D57.02 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.