D57.454
BillableSickle-cell thalassemia beta plus with dactylitis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D57.454 an HCC code?
Yes. D57.454 maps to Sickle Cell Disorders and Thalassemia 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 D57.454
For D57.454 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 D57.454 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D57.454 is the ICD-10-CM diagnosis code for sickle-cell thalassemia beta plus with dactylitis. This is a blood disorder where a person has both sickle cell disease and a milder form of thalassemia, and they are currently experiencing painful swelling in their fingers or toes (dactylitis). This combination of genetic blood disorders causes abnormal hemoglobin that leads to pain crises and tissue damage. D57.454 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, D57.454 maps to Sickle Cell Disorders and Thalassemia (HCC 108) with a community, non-dual, aged base RAF weight of 0.607. Under the older CMS-HCC V24 model, D57.454 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.
Verify documentation specifies both sickle-cell thalassemia beta plus AND the presence of dactylitis; if dactylitis is not documented, use a different D57.45x code without the dactylitis component. Because D57.454 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 D57.454 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation specifies both sickle-cell thalassemia beta plus AND the presence of dactylitis; if dactylitis is not documented, use a different D57.45x code without the dactylitis component
- •Ensure the fifth character '4' is correct for beta plus thalassemia; other fifth characters (0-3) represent different thalassemia types and should not be confused
Clinical Significance
Dactylitis in sickle-cell thalassemia beta plus is typically milder and may present later in childhood compared to Hemoglobin SS or beta-zero genotypes. Because the beta-plus phenotype is generally milder, dactylitis may be less frequent but still serves as an important early clinical sign that can lead to the initial diagnosis of sickle-cell thalassemia in young children.
Documentation Requirements
- ✓Documentation must confirm sickle-cell thalassemia beta plus genotype and the diagnosis of dactylitis with identification of affected extremities.
- ✓Record pain assessment, swelling characteristics, any imaging findings, treatment administered, and clinical course.
- ✓Note the patient's age and whether this led to sickle cell disease diagnosis.
Commonly Confused Codes
- •D57.454 vs. D57.434 (Beta zero with dactylitis) -
- •different thalassemia type. D57.454 vs. D57.414 (Unspecified with dactylitis) -
- •D57.454 specifies beta-plus. D57.454 vs. D57.04 (Hemoglobin SS with dactylitis) -
- •different genotype. D57.454 vs. D57.214 (Hemoglobin SC with dactylitis) -
- •different genotype.