D57.40 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 coding software

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Code lookupD57.40

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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)

D57.40

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Sickle-cell thalassemia without crisis

A blood disorder combining sickle cell disease with thalassemia (another inherited blood condition) without an acute crisis episode.

Buddy Insight

Sickle-cell thalassemia without crisis represents the chronic baseline state of a compound heterozygous condition combining a sickle hemoglobin gene with a thalassemia gene.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 108

Sickle Cell Disorders, Except...

Coefficient HCC 108: 0.146 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 071

HHS-HCC 071 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 46

Severe Hematological Disorders

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

D57Sickle-cell disorders D57.4Sickle-cell thalassemia D57.40Sickle-cell thalassemia without crisis

Inclusion Terms

Official

Microdrepanocytosis
Sickle-cell thalassemia NOS
Sickle-cell beta thalassemiaInherited from D57.4
Thalassemia Hb-S diseaseInherited from D57.4

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

Official

D57.41Sickle-cell thalassemia, unspecified, with crisis D57.42Sickle-cell thalassemia beta zero without crisis D57.43Sickle-cell thalassemia beta zero with crisis D57.44Sickle-cell thalassemia beta plus without crisis D57.45Sickle-cell thalassemia beta plus with crisis

Includes

Official

No Includes notes are included in this display for D57.40. Check the code and parent instructions in the Code Book.

Excludes 1

Official

other hemoglobinopathies (D58.-)Inherited from D57

Code First

Official

No Code First sequencing instructions are included in this display for D57.40. 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

Official

No Code Also instructions are included in this display for D57.40. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Document the sickle-cell thalassemia genotype confirmed by hemoglobin electrophoresis or genetic testing, and specify the thalassemia component as beta-zero or beta-plus when known.

Record baseline hemoglobin, reticulocyte count, current medications (hydroxyurea, folic acid), transfusion history, and screening for complications including retinopathy, avascular necrosis, renal dysfunction, and pulmonary hypertension.

Confirm no active crisis at the encounter.

MEAT Support

HCC Buddy guidance

Document the sickle-cell thalassemia genotype confirmed by hemoglobin electrophoresis or genetic testing, and specify the thalassemia component as beta-zero or beta-plus when known.

Confirm no active crisis at the encounter.

Audit Caution

HCC Buddy guidance

Query the provider for beta-zero vs.

beta-plus specification to ensure accurate HCC mapping.

Beta-zero sickle-cell thalassemia has nearly identical clinical severity to Hemoglobin SS disease, making this distinction clinically important.

Do not assign crisis codes simultaneously with D57.40.

Common Mistakes

HCC Buddy guidance

D57.40 vs. D57.42 (Sickle-cell thalassemia beta zero without crisis) -

use D57.42 when beta-zero is specifically documented. D57.40 vs. D57.44 (Sickle-cell thalassemia beta plus without crisis) -

use D57.44 when beta-plus is documented. D57.40 vs. D57.1 (Hemoglobin SS without crisis) -

different genotype. D57.40 vs. D56.1 (Beta thalassemia) -

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 D57.40 an HCC code?

Yes. D57.40 (Sickle-cell thalassemia without crisis) 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: D57.40 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: D57.40
Description: Sickle-cell thalassemia without crisis
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

V28HCC 108, Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major

0.146

ESRDHCC 46, Severe Hematological Disorders

Not separately weighted

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 D57.40 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for D57.40

For D57.40, 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

D57.40 is the ICD-10-CM diagnosis code for sickle-cell thalassemia without crisis. A blood disorder combining sickle cell disease with thalassemia (another inherited blood condition) without an acute crisis episode. D57.40 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, D57.40 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. 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 code is for stable disease without acute complications; if a crisis occurs, use a more specific code from D57.41x series. For D57.40, 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 D57.40 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This code is for stable disease without acute complications; if a crisis occurs, use a more specific code from D57.41x series
•Document whether the patient is in steady state or experiencing complications to ensure correct code selection

Clinical Significance

Sickle-cell thalassemia without crisis represents the chronic baseline state of a compound heterozygous condition combining a sickle hemoglobin gene with a thalassemia gene. Clinical severity depends on whether the thalassemia component is beta-zero (no beta-globin production) or beta-plus (reduced beta-globin production). This unspecified code is used when the beta-zero vs. beta-plus distinction is not documented. Patients require ongoing monitoring for organ damage, pain management, and disease-modifying therapy.

Documentation Requirements

✓Document the sickle-cell thalassemia genotype confirmed by hemoglobin electrophoresis or genetic testing, and specify the thalassemia component as beta-zero or beta-plus when known.
✓Record baseline hemoglobin, reticulocyte count, current medications (hydroxyurea, folic acid), transfusion history, and screening for complications including retinopathy, avascular necrosis, renal dysfunction, and pulmonary hypertension.
✓Confirm no active crisis at the encounter.

Commonly Confused Codes

•D57.40 vs. D57.42 (Sickle-cell thalassemia beta zero without crisis) -
•use D57.42 when beta-zero is specifically documented. D57.40 vs. D57.44 (Sickle-cell thalassemia beta plus without crisis) -
•use D57.44 when beta-plus is documented. D57.40 vs. D57.1 (Hemoglobin SS without crisis) -
•different genotype. D57.40 vs. D56.1 (Beta thalassemia) -
•D57.40 has both sickle cell and thalassemia components.