What is ICD-10 code D57.459?

D57.459 is the ICD-10-CM diagnosis code for Sickle-cell thalassemia beta plus with crisis, unspecified. A sickle-cell thalassemia condition experiencing a crisis episode, but the specific type of crisis is not documented or specified. D57.459 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. D57.459 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. D57.459 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. D57.459 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does D57.459 map to under V28?

D57.459 maps to CMS-HCC V28 HCC 108 (Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM D57.459: Sickle-cell thalassemia

D57.459 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 Buddy coding tools

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupD57.459

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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)

D57.459

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Sickle-cell thalassemia beta plus with crisis, unspecified

A sickle-cell thalassemia condition experiencing a crisis episode, but the specific type of crisis is not documented or specified.

Buddy Insight

Sickle-cell thalassemia beta plus with crisis represents a combined hemoglobinopathy where patients carry both sickle hemoglobin and beta-plus thalassemia trait, currently in an acute crisis state.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 108

Sickle Cell Disorders, Except...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 071

HHS-HCC 071 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 46

Severe Hematological Disorders

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

D57.4Sickle-cell thalassemia D57.45Sickle-cell thalassemia beta plus with crisis D57.459Sickle-cell thalassemia beta plus with crisis, unspecified

Inclusion Terms

Official

HbS-beta plus with crisis with unspecified complication
Sickle-cell beta plus with crisis with unspecified complication
Sickle-cell thalassemia beta plus with (painful) crisis NOS
Sickle-cell thalassemia beta plus with (vaso-occlusive) pain NOS
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

Official

D57.451Sickle-cell thalassemia beta plus with acute chest syndrome D57.452Sickle-cell thalassemia beta plus with splenic sequestration D57.453Sickle-cell thalassemia beta plus with cerebral vascular involvement D57.454Sickle-cell thalassemia beta plus with dactylitis D57.458Sickle-cell thalassemia beta plus with crisis with other specified complication

Includes

Official

No Includes notes are included in this display for D57.459. Check the code and parent instructions in the Code Book.

Excludes 1

Official

other hemoglobinopathies (D58.-)Inherited from D57

Code First

Official

No Code First sequencing instructions are included in this display for D57.459. 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

Official

No Code Also instructions are included in this display for D57.459. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Document the specific type of crisis (vaso-occlusive, acute chest syndrome, splenic sequestration, cerebral vascular involvement, or dactylitis).

Record hemoglobin electrophoresis results confirming beta-plus thalassemia variant.

Include current hemoglobin/hematocrit levels, reticulocyte count, and any end-organ damage.

Document pain severity, location, and duration if vaso-occlusive crisis is present.

MEAT Support

HCC Buddy guidance

Document the specific type of crisis (vaso-occlusive, acute chest syndrome, splenic sequestration, cerebral vascular involvement, or dactylitis).

Record hemoglobin electrophoresis results confirming beta-plus thalassemia variant.

Include current hemoglobin/hematocrit levels, reticulocyte count, and any end-organ damage.

Document pain severity, location, and duration if vaso-occlusive crisis is present.

Audit Caution

HCC Buddy guidance

Do not default to unspecified crisis when the provider has documented the crisis type -

use the specific 5th/6th character codes (D57.451 for acute chest syndrome, D57.452 for splenic sequestration, etc.). Query the provider to determine the specific crisis type rather than accepting unspecified documentation. Ensure the beta-plus designation is confirmed rather than assumed.

Common Mistakes

HCC Buddy guidance

D57.419 (Sickle-cell thalassemia beta zero with crisis, unspecified) represents the more severe beta-zero variant where no normal beta-globin is produced.

D57.40 vs D57.459 distinguishes the beta-zero from beta-plus subtype.

D57.819 (Other sickle-cell disorders with crisis, unspecified) is used when the specific sickle-cell variant is different from thalassemia combinations.

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 D57.459 an HCC code?

Yes. D57.459 (Sickle-cell thalassemia beta plus with crisis, unspecified) 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: D57.459 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: D57.459
Description: Sickle-cell thalassemia beta plus with crisis, unspecified
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

V28HCC 108, Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major

0.146

ESRDHCC 46, Severe Hematological Disorders

Not separately weighted

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 D57.459 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for D57.459

For D57.459, 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

Get the V28 mapping + MEAT cheat sheet

One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.

Free PDF. No card. Unsubscribe anytime.

What This Code Means

D57.459 is the ICD-10-CM diagnosis code for sickle-cell thalassemia beta plus with crisis, unspecified. A sickle-cell thalassemia condition experiencing a crisis episode, but the specific type of crisis is not documented or specified. D57.459 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, D57.459 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. No V24 mapping is shown for D57.459; use the applicable model and payment year when reviewing the V28 mapping. 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.

This is a default code when a crisis is present but the specific complication cannot be determined. For D57.459, 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 D57.459 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This is a default code when a crisis is present but the specific complication cannot be determined
•Query the provider if possible to identify the specific crisis type for more accurate coding

Clinical Significance

Sickle-cell thalassemia beta plus with crisis represents a combined hemoglobinopathy where patients carry both sickle hemoglobin and beta-plus thalassemia trait, currently in an acute crisis state. The unspecified crisis designation means the documentation does not clarify whether the crisis involves vaso-occlusive pain, acute chest syndrome, splenic sequestration, or cerebral vascular events. These patients require urgent evaluation and management, and the lack of crisis specificity represents a documentation gap that should be addressed through provider query.

Documentation Requirements

✓Document the specific type of crisis (vaso-occlusive, acute chest syndrome, splenic sequestration, cerebral vascular involvement, or dactylitis).
✓Record hemoglobin electrophoresis results confirming beta-plus thalassemia variant.
✓Include current hemoglobin/hematocrit levels, reticulocyte count, and any end-organ damage.
✓Document pain severity, location, and duration if vaso-occlusive crisis is present.

Commonly Confused Codes

•D57.419 (Sickle-cell thalassemia beta zero with crisis, unspecified) represents the more severe beta-zero variant where no normal beta-globin is produced.
•D57.40 vs D57.459 distinguishes the beta-zero from beta-plus subtype.
•D57.819 (Other sickle-cell disorders with crisis, unspecified) is used when the specific sickle-cell variant is different from thalassemia combinations.