D57.03
BillableHb-SS disease with cerebral vascular involvement
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D57.03 an HCC code?
Yes. D57.03 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 D57.03
For D57.03 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 D57.03 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D57.03 is the ICD-10-CM diagnosis code for hb-ss disease with cerebral vascular involvement. Sickle cell disease with an acute crisis involving stroke or other blood vessel problems in the brain due to sickled red blood cells blocking blood flow. D57.03 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, D57.03 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, D57.03 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.
Coordinate with neurology documentation or imaging reports confirming cerebrovascular event. Because D57.03 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 D57.03 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Coordinate with neurology documentation or imaging reports confirming cerebrovascular event
- •Document whether this is acute stroke, transient ischemic attack, or other cerebrovascular involvement during crisis
Clinical Significance
Cerebral vascular involvement in Hemoglobin SS disease represents one of the most devastating complications of sickle cell disease, including ischemic stroke, hemorrhagic stroke, transient ischemic attacks, and silent cerebral infarcts. Stroke occurs in approximately 11% of children with Hemoglobin SS disease by age 20. The sickled red blood cells cause large vessel vasculopathy in the Circle of Willis, leading to stenosis, occlusion, and moyamoya-pattern collaterals with significant long-term neurological disability.
Documentation Requirements
- ✓Documentation must include Hemoglobin SS genotype, neurological examination findings, neuroimaging results (Magnetic Resonance Imaging, Magnetic Resonance Angiography, or Computed Tomography), and the specific cerebrovascular event type (ischemic stroke, hemorrhagic stroke, transient ischemic attack, or silent cerebral infarct).
- ✓Record transcranial Doppler results if available, chronic transfusion therapy protocol, and neurological deficits.
- ✓Document whether this is a new event or recurrence.
Code Also
- , if applicable, cerebral infarction (I63.-)