D57.1 ICD-10-CM Code: Sickle-cell disease without crisis

Code

D57.1

Description

Sickle-cell disease without crisis

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

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 D57.1 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for D57.1

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for D57.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Use only when no acute crisis is present; if any crisis develops, use D57.00-D57.09 instead
• •Document baseline hemoglobin levels and steady-state clinical status to support this code selection

Clinical Significance

Sickle cell disease without crisis represents the chronic baseline state of Hemoglobin SS disease when the patient is not experiencing an acute vaso-occlusive or hemolytic crisis. Even in steady state, patients have chronic hemolytic anemia, elevated baseline pain levels, and ongoing organ damage from repeated sickling episodes. This code captures the chronic disease burden that persists between acute crises, including chronic pain management, disease-modifying therapy (hydroxyurea), and surveillance for silent organ damage.

Documentation Requirements

• ✓Document the Hemoglobin SS genotype, confirm the patient is not in acute crisis at the encounter, and record baseline hemoglobin, reticulocyte count, and lactate dehydrogenase.
• ✓Document current medications including hydroxyurea dosing and compliance, chronic transfusion protocol if applicable, vaccination status (particularly pneumococcal), screening results for pulmonary hypertension, renal function, and retinopathy.
• ✓Record pain management regimen for chronic sickle cell pain.

Commonly Confused Codes

• •D57.1 vs. D57.00-D57.09 (Hemoglobin SS with crisis) -
• •use D57.1 only when the patient is in steady state without active crisis. D57.1 vs. D57.20 (Sickle-cell/Hemoglobin C without crisis) -
• •different sickle cell genotype. D57.1 vs. D57.3 (Sickle-cell trait) -
• •trait is the carrier state (Hemoglobin AS) and is a fundamentally different clinical entity than sickle cell disease (Hemoglobin SS).

Child Codes