D57.434

HCC Category Mapping

What This Code Means

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.

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.

Commonly Confused Codes