D57.458
BillableSickle-cell thalassemia beta plus 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 D57.458 an HCC code?
Yes. D57.458 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 D57.458
For D57.458 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 D57.458 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D57.458 is the ICD-10-CM diagnosis code for sickle-cell thalassemia beta plus with crisis with other specified complication. A sickle-cell thalassemia condition with a crisis episode and another specific complication not listed in standard categories. D57.458 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, D57.458 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, D57.458 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.
Use this code only when the specific complication is documented but doesn't fit other defined categories. Because D57.458 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 D57.458 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the specific complication is documented but doesn't fit other defined categories
- •Always document the nature of the 'other specified complication' in the medical record for clarity
Clinical Significance
This code captures sickle-cell thalassemia beta plus crises with specified complications outside the standard categories (acute chest syndrome, splenic sequestration, cerebral vascular involvement, dactylitis). In beta-plus patients, these may include priapism, hepatic complications, aplastic crisis triggered by parvovirus B19, or renal manifestations. While generally milder than equivalent beta-zero or Hemoglobin SS complications, they still require acute management and may result in organ damage.
Documentation Requirements
- ✓Documentation must confirm sickle-cell thalassemia beta plus genotype and identify the specific crisis complication not covered by D57.451-D57.
- ✓The provider should describe the complication type, clinical presentation, diagnostic findings, treatment, and outcome. Record any resulting organ damage.