D57.219
BillableSickle-cell/Hb-C disease with crisis, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D57.219 an HCC code?
Yes. D57.219 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 D57.219
For D57.219 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 D57.219 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D57.219 is the ICD-10-CM diagnosis code for sickle-cell/hb-c disease with crisis, unspecified. A blood disorder combining sickle cell disease and hemoglobin C disease with a sudden crisis episode, but the specific type of complication is not documented or specified. D57.219 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, D57.219 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, D57.219 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.
This is a default code when crisis is documented but the specific complication type cannot be determined from the record. Because D57.219 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 D57.219 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a default code when crisis is documented but the specific complication type cannot be determined from the record
- •Query the provider if possible to identify the specific crisis type for more precise coding
Clinical Significance
This unspecified crisis code for sickle-cell/Hemoglobin C disease indicates the patient experienced an acute exacerbation but the specific type of crisis complication was not documented. Hemoglobin SC crises are generally less frequent and less severe than Hemoglobin SS crises but still carry significant morbidity. This code represents a documentation improvement opportunity -- providers should specify the crisis type whenever possible.
Documentation Requirements
- ✓Documentation must confirm the Hemoglobin SC genotype and that an acute crisis is occurring during the encounter.
- ✓Record pain location and severity, vital signs, laboratory findings, treatment administered, and clinical course.
- ✓Query the provider to specify the crisis type (acute chest syndrome, splenic sequestration, cerebral vascular involvement, dactylitis, or other) for more precise coding.