D57.431 ICD-10-CM Code: Sickle-cell thalassemia beta zero with acute chest syndrome
D57.431 maps to CMS-HCC V28 107. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC 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)
D57.431
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceSickle-cell thalassemia beta zero with acute chest syndrome
A combination blood disorder with sickle-cell and thalassemia beta-zero that causes acute chest syndrome, a serious lung complication with chest pain and breathing difficulty.
Buddy Insight
Acute chest syndrome in sickle-cell thalassemia beta zero carries the same life-threatening risk as in Hemoglobin SS disease because the beta-zero genotype produces a clinically equivalent phenotype.
CMS-HCC V28
MappedHCC 107
Coefficient HCC 107: 0.457 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 070
Code-level coefficient reference
ESRD/PACE
MappedHCC 46
Code-level coefficient reference
RXHCC
MappedHCC 95
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- HbS-beta zero with acute chest syndrome
- Sickle-cell beta zero with acute chest syndrome
- Sickle-cell beta thalassemiaInherited from D57.4, D57.43
- Thalassemia Hb-S diseaseInherited from D57.4, D57.43
- HbS-beta zero with crisisInherited from D57.4, D57.43
- Sickle-cell beta zero with crisisInherited from D57.4, D57.43
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 D57.431. 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 D57.431. 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 D57.431. 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 D57.431 an HCC code?
Yes. D57.431 (Sickle-cell thalassemia beta zero with acute chest syndrome) maps to HCC 107, Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.457. 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: D57.431 is billable and maps to V28 HCC 107, Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- D57.431
- Description
- Sickle-cell thalassemia beta zero with acute chest syndrome
- HCC (V28)
- HCC 107 — Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero
- RAF reference coefficient
- 0.457
- 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 D57.431 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for D57.431
For D57.431, 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
D57.431 is the ICD-10-CM diagnosis code for sickle-cell thalassemia beta zero with acute chest syndrome. A combination blood disorder with sickle-cell and thalassemia beta-zero that causes acute chest syndrome, a serious lung complication with chest pain and breathing difficulty. D57.431 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, D57.431 maps to Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero (HCC 107) with a source-labeled community, non-dual, aged reference coefficient of 0.457. 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.
Acute chest syndrome is a medical emergency; ensure documentation clearly describes respiratory symptoms, chest pain, and imaging findings. For D57.431, 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 D57.431 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Acute chest syndrome is a medical emergency; ensure documentation clearly describes respiratory symptoms, chest pain, and imaging findings
- •Verify beta-zero thalassemia is specifically documented; beta-plus thalassemia uses code D57.451 for the same complication
Clinical Significance
Acute chest syndrome in sickle-cell thalassemia beta zero carries the same life-threatening risk as in Hemoglobin SS disease because the beta-zero genotype produces a clinically equivalent phenotype. These patients develop new pulmonary infiltrates with respiratory symptoms and may deteriorate rapidly, requiring exchange transfusion and intensive care. The recognition of beta-zero status is important because management intensity mirrors Hemoglobin SS protocols.
Documentation Requirements
- ✓Documentation must confirm sickle-cell thalassemia beta zero genotype and the explicit diagnosis of acute chest syndrome with new pulmonary infiltrate and respiratory symptoms. Record oxygen saturation, arterial blood gas values, chest imaging findings, treatment (exchange transfusion targeting Hemoglobin S <30%, antibiotics, respiratory support), and clinical course. The provider must document 'acute chest syndrome' -
- ✓do not infer from imaging.
Commonly Confused Codes
- •D57.431 vs. D57.411 (Unspecified sickle-cell thalassemia with acute chest syndrome) -
- •D57.431 specifies beta-zero, yielding higher HCC mapping. D57.431 vs. D57.451 (Beta plus with acute chest syndrome) -
- •different thalassemia type with different clinical severity. D57.431 vs. D57.01 (Hemoglobin SS with acute chest syndrome) -
- •clinically similar but genetically distinct.