D57.434
BillableSickle-cell thalassemia beta zero with dactylitis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D57.434 an HCC code?
Yes. D57.434 maps to Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero 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 D57.434
For D57.434 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 D57.434 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D57.434 is the ICD-10-CM diagnosis code for sickle-cell thalassemia beta zero with dactylitis. A combination blood disorder with sickle-cell and thalassemia beta-zero causing dactylitis, which is painful swelling of the hands and feet due to bone infarction. D57.434 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, D57.434 maps to Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero (HCC 107) with a community, non-dual, aged base RAF weight of 0.727. Under the older CMS-HCC V24 model, D57.434 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.
Dactylitis is often called 'hand-foot syndrome'; ensure documentation specifies which extremities are affected and confirms the diagnosis. Because D57.434 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 D57.434 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Dactylitis is often called 'hand-foot syndrome'; ensure documentation specifies which extremities are affected and confirms the diagnosis
- •This complication can occur with or without other crisis symptoms; code accordingly based on whether a broader crisis is also present
Clinical Significance
Dactylitis in sickle-cell thalassemia beta zero presents with the same vaso-occlusive hand and foot swelling seen in Hemoglobin SS disease, typically in infants and young children. Because beta-zero sickle-cell thalassemia has a clinical phenotype indistinguishable from Hemoglobin SS, dactylitis may be equally severe and serve as an early predictor of a severe disease course requiring aggressive management.
Documentation Requirements
- ✓Documentation must confirm sickle-cell thalassemia beta zero genotype and the diagnosis of dactylitis with identification of affected extremities, swelling, and tenderness.
- ✓Record pain assessment, any imaging findings, treatment administered, and clinical course.
- ✓Note the patient's age and whether this presentation contributed to the initial sickle cell diagnosis.