D57.454 ICD-10-CM Code: Sickle-cell thalassemia beta plus with dactylitis
D57.454 maps to CMS-HCC V28 108. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software
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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)
D57.454
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceSickle-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.
Buddy Insight
Dactylitis in sickle-cell thalassemia beta plus is typically milder and may present later in childhood compared to Hemoglobin SS or beta-zero genotypes.
CMS-HCC V28
MappedHCC 108
Coefficient HCC 108: 0.146 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 071
Code-level coefficient reference
ESRD/PACE
MappedHCC 46
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Sickle-cell beta thalassemiaInherited from D57.4, D57.45
- Thalassemia Hb-S diseaseInherited from D57.4, D57.45
- HbS-beta plus with crisisInherited from D57.4, D57.45
- Sickle-cell beta plus with crisisInherited from D57.4, D57.45
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 D57.454. 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 D57.454. Check the code and parent instructions in the Code Book.
Use Additional
Official- code for any associated fever (R50.81)Inherited from D57
Code Also
OfficialNo Code Also instructions are included in this display for D57.454. 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 D57.454 an HCC code?
Yes. D57.454 (Sickle-cell thalassemia beta plus with dactylitis) maps to HCC 108, Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.146. 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: D57.454 is billable and maps to V28 HCC 108, Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- D57.454
- Description
- Sickle-cell thalassemia beta plus with dactylitis
- HCC (V28)
- HCC 108 — Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major
- RAF reference coefficient
- 0.146
- 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 D57.454 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for D57.454
For D57.454, 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
D57.454 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, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major (HCC 108) with a source-labeled community, non-dual, aged reference coefficient of 0.146. 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.
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. For D57.454, 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 D57.454 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.