D57.438
BillableSickle-cell thalassemia beta zero with crisis with other specified complication
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D57.438 an HCC code?
Yes. D57.438 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 D57.438
For D57.438 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 D57.438 during that encounter — not just copy-forwarded from a problem list.
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 community, non-dual, aged base RAF weight of 0.727. Under the older CMS-HCC V24 model, D57.438 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.
Document the specific complication clearly (e.g., acute kidney injury, priapism, splenic sequestration) to justify the 'other specified' code. Because D57.438 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 D57.438 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.