D57.218
BillableSickle-cell/Hb-C disease with crisis with other specified complication
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D57.218 an HCC code?
Yes. D57.218 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 D57.218
For D57.218 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 D57.218 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D57.218 is the ICD-10-CM diagnosis code for sickle-cell/hb-c disease with crisis with other specified complication. A blood disorder combining sickle cell disease and hemoglobin C disease with a sudden crisis episode involving complications other than those specifically listed. D57.218 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, D57.218 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, D57.218 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.
Use this code when documentation describes a specific complication not captured by D57.211-214; clearly document what the complication is. Because D57.218 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 D57.218 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code when documentation describes a specific complication not captured by D57.211-214; clearly document what the complication is
- •Ensure the complication is acute and crisis-related, not a chronic manifestation
Clinical Significance
This code captures sickle-cell/Hemoglobin C disease crises with specified complications not classified under acute chest syndrome, splenic sequestration, cerebral vascular involvement, or dactylitis. Hemoglobin SC-specific complications may include proliferative retinopathy crisis, avascular necrosis exacerbation, priapism, hepatic sequestration, or renal complications. Hemoglobin SC patients are particularly prone to retinal and orthopedic complications compared to other sickle cell genotypes.
Documentation Requirements
- ✓Documentation must confirm the Hemoglobin SC genotype and identify the specific crisis complication.
- ✓The provider should describe the complication type, clinical presentation, supporting diagnostic findings, treatment administered, and clinical outcome.
- ✓Record whether the complication results in permanent organ damage.
- ✓Specify why the complication does not fit into the D57.211-D57.214 categories.