D57.20 ICD-10-CM Code: Sickle-cell/Hb-C disease without crisis
D57.20 maps to CMS-HCC V28 108 (RAF 0.146). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools
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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)
D57.20
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceSickle-cell/Hb-C disease without crisis
A combination of sickle cell disease and hemoglobin C disease without an acute crisis, causing chronic anemia and abnormal red blood cells in a stable state.
Buddy Insight
Sickle-cell/Hemoglobin C disease (Hemoglobin SC) is a compound heterozygous condition where the patient inherits one sickle hemoglobin gene and one hemoglobin C gene.
CMS-HCC V28
MappedHCC 108
RAF 0.146
CMS-HCC V24
MappedHCC 46
RAF 1.372
ACA/HHS
MappedHCC 71
Varies by metal level
ESRD/PACE
MappedHCC 46
RAF 0.223
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Hb-SC disease
- Hb-S/Hb-C disease
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for D57.20 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for D57.20 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for D57.20 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for D57.20 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for D57.20 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for D57.20 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 D57.20 an HCC code?
Yes. D57.20 (Sickle-cell/Hb-C disease without crisis) maps to Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major under the CMS-HCC V28 risk adjustment model (and Severe Hematological Disorders under V24), with a community non-dual aged RAF of 0.146. It is billable for payment year 2026.
Coder answer: D57.20 is billable and maps to V28 HCC 108, Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- D57.20
- Description
- Sickle-cell/Hb-C disease without crisis
- HCC (V28)
- HCC 108 — Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major
- RAF
- 0.146
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so 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 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.
Work D57.20 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for D57.20
For D57.20 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 D57.20 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
D57.20 is the ICD-10-CM diagnosis code for sickle-cell/hb-c disease without crisis. A combination of sickle cell disease and hemoglobin C disease without an acute crisis, causing chronic anemia and abnormal red blood cells in a stable state. D57.20 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, D57.20 maps to Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major (HCC 108) with a community, non-dual, aged base RAF weight of 0.146. Under the older CMS-HCC V24 model, D57.20 maps to Severe Hematological Disorders (HCC 46) with a community, non-dual, aged base RAF weight of 1.372. 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.
Confirm both sickle hemoglobin and hemoglobin C are present through hemoglobin electrophoresis documentation. Because D57.20 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 D57.20 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm both sickle hemoglobin and hemoglobin C are present through hemoglobin electrophoresis documentation
- •Use only when patient is not experiencing acute crisis; if crisis develops, use appropriate D57.2x crisis code
Clinical Significance
Sickle-cell/Hemoglobin C disease (Hemoglobin SC) is a compound heterozygous condition where the patient inherits one sickle hemoglobin gene and one hemoglobin C gene. It is the second most common sickle cell genotype and is generally milder than Hemoglobin SS disease, with higher baseline hemoglobin and less frequent pain crises. However, patients are at increased risk for retinopathy, avascular necrosis, and splenic complications including sequestration and infarction in adulthood.
Documentation Requirements
- ✓Documentation must confirm the Hemoglobin SC genotype through hemoglobin electrophoresis or genetic testing, and confirm the patient is not in acute crisis.
- ✓Record baseline hemoglobin, reticulocyte count, and current medications.
- ✓Document screening for retinopathy (annual ophthalmologic exam), avascular necrosis, and splenic function.
- ✓Note any disease-modifying therapy and vaccination status.
Commonly Confused Codes
- •D57.20 vs. D57.1 (Sickle-cell disease without crisis) -
- •D57.1 is specifically for Hemoglobin SS genotype. D57.20 vs. D57.40 (Sickle-cell thalassemia without crisis) -
- •different co-inherited condition. D57.20 vs. D57.219 (Sickle-cell/Hemoglobin C with crisis, unspecified) -
- •use D57.20 only when no crisis is present. D57.20 vs. D57.3 (Sickle-cell trait) -
- •Hemoglobin SC disease is a compound heterozygous disease, not a carrier state.