D57.419
BillableSickle-cell thalassemia, unspecified, with crisis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D57.419 an HCC code?
Yes. D57.419 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 D57.419
For D57.419 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 D57.419 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D57.419 is the ICD-10-CM diagnosis code for sickle-cell thalassemia, unspecified, with crisis. A combination blood disorder mixing sickle-cell disease and thalassemia that is currently experiencing a crisis, with the specific type of crisis not further specified. D57.419 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, D57.419 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, D57.419 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 a sickle-cell thalassemia crisis is documented but no specific complication (chest syndrome, stroke, etc.) is identified. Because D57.419 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 D57.419 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code when a sickle-cell thalassemia crisis is documented but no specific complication (chest syndrome, stroke, etc.) is identified
- •Query the provider if documentation mentions specific complications like acute chest syndrome or splenic sequestration, as more specific codes may apply
Clinical Significance
This unspecified crisis code for sickle-cell thalassemia indicates the patient experienced an acute exacerbation but neither the crisis type nor the thalassemia subtype was documented. This represents a dual documentation improvement opportunity -- both the crisis specification and the thalassemia type (beta-zero vs. beta-plus) should be queried. The clinical management varies significantly based on both parameters.
Documentation Requirements
- ✓Documentation must confirm the sickle-cell thalassemia genotype and that an acute crisis is present.
- ✓Query the provider for: (1) the thalassemia type (beta-zero vs.
- ✓beta-plus) and (2) the specific crisis type (acute chest syndrome, splenic sequestration, cerebral vascular involvement, dactylitis, or other).
- ✓Record pain severity, vital signs, laboratory findings, treatment, and clinical course.
Commonly Confused Codes
- •D57.419 vs. D57.411-D57.418 (Sickle-cell thalassemia with specific crisis types) -
- •query for specificity. D57.419 vs. D57.439 (Beta zero with crisis, unspecified) -
- •use when beta-zero is confirmed. D57.419 vs. D57.40 (Sickle-cell thalassemia without crisis) -
- •D57.40 is for steady state. D57.419 vs. D57.00 (Hemoglobin SS with crisis, unspecified) -
- •different genotype.