D57.04
BillableHb-SS disease with dactylitis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D57.04 an HCC code?
Yes. D57.04 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 D57.04
For D57.04 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 D57.04 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D57.04 is the ICD-10-CM diagnosis code for hb-ss disease with dactylitis. Sickle cell disease with an acute crisis causing severe pain and swelling in the hands and feet due to blocked blood vessels in these areas. D57.04 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, D57.04 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, D57.04 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.
Dactylitis (hand-foot syndrome) is often seen in children; document affected extremities and clinical presentation. Because D57.04 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 D57.04 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Dactylitis (hand-foot syndrome) is often seen in children; document affected extremities and clinical presentation
- •Ensure acute crisis status is documented; this code indicates dactylitis as the crisis complication
Clinical Significance
Dactylitis (hand-foot syndrome) in Hemoglobin SS disease is a painful vaso-occlusive crisis affecting the small bones of the hands and feet, often the earliest clinical manifestation of sickle cell disease appearing in infants between 6 months and 2 years of age. It presents with bilateral painful swelling of the dorsal aspects of the hands and feet with underlying bony infarction. While typically self-limiting, it is a predictor of severe sickle cell disease course and may be the presenting symptom that leads to diagnosis.
Documentation Requirements
- ✓Documentation must confirm Hemoglobin SS genotype and the specific diagnosis of dactylitis with description of affected extremities, swelling, tenderness, and imaging findings if obtained (radiographic periosteal elevation or bony changes).
- ✓Record pain management administered, clinical course, and any concurrent fever or infection.
- ✓Note the patient's age at presentation as this carries prognostic significance for disease severity.
Commonly Confused Codes
- •D57.04 vs. D57.00 (Hemoglobin SS with crisis, unspecified) -
- •use D57.04 when dactylitis is specifically documented as the crisis type. D57.04 vs. M79.89 (Other specified soft tissue disorders) -
- •dactylitis in sickle cell disease requires the sickle cell-specific code. D57.04 vs. D57.214 (Sickle-cell/Hemoglobin C with dactylitis) -
- •different sickle cell genotype.