D57.411
BillableSickle-cell thalassemia, unspecified, with acute chest syndrome
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D57.411 an HCC code?
Yes. D57.411 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 D57.411
For D57.411 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 D57.411 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D57.411 is the ICD-10-CM diagnosis code for sickle-cell thalassemia, unspecified, with acute chest syndrome. A blood disorder combining sickle cell disease with thalassemia that causes a sudden, life-threatening complication affecting the lungs with chest pain and difficulty breathing. D57.411 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, D57.411 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, D57.411 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.
Acute chest syndrome in sickle-cell thalassemia is a medical emergency; ensure acute status is clearly documented. Because D57.411 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 D57.411 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Acute chest syndrome in sickle-cell thalassemia is a medical emergency; ensure acute status is clearly documented
- •This code indicates both the underlying disease and the acute pulmonary complication
Clinical Significance
Acute chest syndrome in unspecified sickle-cell thalassemia represents a life-threatening pulmonary complication in patients with combined sickle cell and thalassemia genes where the specific thalassemia type (beta-zero vs. beta-plus) is not documented. The clinical presentation and management are similar to acute chest syndrome in other sickle cell genotypes, with new pulmonary infiltrate, respiratory distress, and potential for rapid deterioration requiring intensive care.
Documentation Requirements
- ✓Documentation must confirm the sickle-cell thalassemia genotype and the clinical diagnosis of acute chest syndrome with respiratory symptoms and new pulmonary infiltrate on imaging.
- ✓Query the provider for beta-zero vs.
- ✓beta-plus thalassemia specification.
- ✓Record oxygen saturation, treatment including transfusion protocol, antibiotics, respiratory support, and clinical course.
- ✓The provider must explicitly diagnose acute chest syndrome.
Commonly Confused Codes
- •D57.411 vs. D57.431 (Sickle-cell thalassemia beta zero with acute chest syndrome) -
- •use D57.431 when beta-zero is specifically documented. D57.411 vs. D57.451 (Sickle-cell thalassemia beta plus with acute chest syndrome) -
- •use D57.451 when beta-plus is documented. D57.411 vs. D57.01 (Hemoglobin SS with acute chest syndrome) -
- •different genotype.