D57.438 ICD-10-CM Code: Sickle-cell thalassemia beta zero with crisis with other specified complication
D57.438 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 · HCC Buddy 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)
D57.438
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceSickle-cell thalassemia beta zero with crisis with other specified complication
A combination blood disorder with sickle-cell and thalassemia beta-zero experiencing a crisis with additional specified complications other than chest syndrome, stroke, or dactylitis.
Buddy Insight
This code captures sickle-cell thalassemia beta zero crises with specified complications not classified elsewhere, including priapism, hepatic sequestration, aplastic crisis, renal complications, or other organ-specific vaso-occlusive events.
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 other specified complication
- Sickle-cell beta zero with other specified complication
- 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 D57.438. 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 D57.438. Check the code and parent instructions in the Code Book.
Use Additional
Official- code to identify complications, such as:
- cholelithiasis (K80.-)
- priapism (N48.32)
- code for any associated fever (R50.81)Inherited from D57
Code Also
OfficialNo Code Also instructions are included in this display for D57.438. 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 D57.438 an HCC code?
Yes. D57.438 (Sickle-cell thalassemia beta zero with crisis with other specified complication) 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: D57.438 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
- D57.438
- Description
- Sickle-cell thalassemia beta zero with crisis with other specified complication
- 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 D57.438 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for D57.438
For D57.438, 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
D57.438 is the ICD-10-CM diagnosis code for sickle-cell thalassemia beta zero with crisis with other specified complication. A combination blood disorder with sickle-cell and thalassemia beta-zero experiencing a crisis with additional specified complications other than chest syndrome, stroke, or dactylitis. D57.438 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, D57.438 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.
Document the specific complication clearly (e.g., acute kidney injury, priapism, splenic sequestration) to justify the 'other specified' code. For D57.438, 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 D57.438 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
This code captures sickle-cell thalassemia beta zero crises with specified complications not classified elsewhere, including priapism, hepatic sequestration, aplastic crisis, renal complications, or other organ-specific vaso-occlusive events. Because beta-zero sickle-cell thalassemia has identical clinical severity to Hemoglobin SS disease, these complications carry the same high morbidity and management intensity as equivalent Hemoglobin SS complications.
Documentation Requirements
- ✓Documentation must confirm sickle-cell thalassemia beta zero genotype and identify the specific crisis complication.
- ✓The provider should describe the complication type, clinical presentation, diagnostic findings, treatment, and outcome.
- ✓Record any permanent organ damage resulting from the crisis.
- ✓Specify why the complication does not fit D57.431-D57.434 categories.
Commonly Confused Codes
- •D57.438 vs. D57.418 (Unspecified sickle-cell thalassemia with other specified complication) -
- •D57.438 specifies beta-zero. D57.438 vs. D57.458 (Beta plus with other specified complication) -
- •different thalassemia type. D57.438 vs. D57.439 (Beta zero with crisis, unspecified) -
- •use D57.438 when a specific complication is identified.