D57.219 ICD-10-CM Code: Sickle-cell/Hb-C disease with crisis, unspecified
D57.219 maps to CMS-HCC V28 108. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC Buddy 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)
D57.219
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceSickle-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.
Buddy Insight
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.
CMS-HCC V28
MappedHCC 108
Coefficient HCC 108: 0.146 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 071
Code-level coefficient reference
ESRD/PACE
MappedHCC 46
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Sickle-cell/Hb-C disease with crisis NOS
- Sickle-cell/Hb-C disease with (vaso-occlusive) pain NOS
- Hb-SC diseaseInherited from D57.2
- Hb-S/Hb-C diseaseInherited from D57.2
Excludes 2
Official- autoimmune disease (systemic) NOS (M35.9)Inherited from D50-D89
- certain conditions originating in the perinatal period (P00-P96)Inherited from D50-D89
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from D50-D89
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from D50-D89
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from D50-D89
- human immunodeficiency virus [HIV] disease (B20)Inherited from D50-D89
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from D50-D89
- neoplasms (C00-D49)Inherited from D50-D89
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from D50-D89
Related Codes
Includes
OfficialNo Includes notes are included in this display for D57.219. Check the code and parent instructions in the Code Book.
Excludes 1
Official- other hemoglobinopathies (D58.-)Inherited from D57
Code First
OfficialNo Code First sequencing instructions are included in this display for D57.219. Check the code and parent instructions in the Code Book.
Use Additional
Official- code for any associated fever (R50.81)Inherited from D57
Code Also
OfficialNo Code Also instructions are included in this display for D57.219. Check the code and parent instructions in the Code Book.
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 D57.219 an HCC code?
Yes. D57.219 (Sickle-cell/Hb-C disease with crisis, unspecified) maps to HCC 108, Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.146. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: D57.219 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
- D57.219
- Description
- Sickle-cell/Hb-C disease with crisis, unspecified
- HCC (V28)
- HCC 108 — Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major
- RAF reference coefficient
- 0.146
- 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 D57.219 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for D57.219
For D57.219, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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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, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major (HCC 108) with a source-labeled community, non-dual, aged reference coefficient of 0.146. No V24 mapping is shown for D57.219; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
This is a default code when crisis is documented but the specific complication type cannot be determined from the record. For D57.219, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, 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.
Commonly Confused Codes
- •D57.219 vs. D57.211-D57.218 (Sickle-cell/Hemoglobin C with specific crisis types) -
- •query for specificity to assign the correct crisis code. D57.219 vs. D57.20 (Sickle-cell/Hemoglobin C without crisis) -
- •D57.20 is for steady state, D57.219 is for active crisis. D57.219 vs. D57.00 (Hemoglobin SS with crisis, unspecified) -
- •different sickle cell genotype.