D57.214
BillableSickle-cell/Hb-C disease with dactylitis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D57.214 an HCC code?
Yes. D57.214 maps to Sickle Cell Disorders and Thalassemia 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 D57.214
For D57.214 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 D57.214 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D57.214 is the ICD-10-CM diagnosis code for sickle-cell/hb-c disease with dactylitis. A blood disorder combining sickle cell disease and hemoglobin C disease that causes severe pain and swelling in the hands and feet due to blocked blood vessels. D57.214 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, D57.214 maps to Sickle Cell Disorders and Thalassemia (HCC 108) with a community, non-dual, aged base RAF weight of 0.607. Under the older CMS-HCC V24 model, D57.214 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 common in sickle cell disease; ensure documentation specifies which extremities are affected. Because D57.214 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 D57.214 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 common in sickle cell disease; ensure documentation specifies which extremities are affected
- •Verify this represents acute dactylitis crisis rather than chronic pain management
Clinical Significance
Dactylitis in sickle-cell/Hemoglobin C disease represents painful swelling of the hands and feet from vaso-occlusion in the small bones, though it is less common in Hemoglobin SC than in Hemoglobin SS disease. In Hemoglobin SC patients, dactylitis may present later in childhood and with milder symptoms compared to Hemoglobin SS. It remains an important early sign of sickle cell disease that may lead to initial diagnosis.
Documentation Requirements
- ✓Documentation must confirm the Hemoglobin SC genotype and the specific diagnosis of dactylitis with description of affected extremities, swelling, and tenderness.
- ✓Record pain severity and management, any imaging findings showing bony changes, and the clinical course.
- ✓Note the patient's age at presentation and whether this led to the initial sickle cell disease diagnosis.
Commonly Confused Codes
- •D57.214 vs. D57.04 (Hemoglobin SS with dactylitis) -
- •different sickle cell genotype. D57.214 vs. D57.219 (Sickle-cell/Hemoglobin C with crisis, unspecified) -
- •use D57.214 when dactylitis is specifically documented. D57.214 vs. M79.89 (Other specified soft tissue disorders) -
- •dactylitis in sickle cell context requires the sickle cell-specific code.