D57.811
BillableOther sickle-cell disorders with acute chest syndrome
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D57.811 an HCC code?
Yes. D57.811 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 D57.811
For D57.811 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 D57.811 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D57.811 is the ICD-10-CM diagnosis code for other sickle-cell disorders with acute chest syndrome. A rare sickle-cell disorder with acute chest syndrome, a serious lung complication causing chest pain and breathing difficulty. D57.811 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, D57.811 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, D57.811 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.
Acute chest syndrome is a medical emergency; ensure it is clearly documented in the clinical record. Because D57.811 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 D57.811 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Acute chest syndrome is a medical emergency; ensure it is clearly documented in the clinical record
- •This code indicates a crisis state, so document supporting symptoms like fever, chest pain, or respiratory distress
Clinical Significance
Other sickle-cell disorders with acute chest syndrome represents a life-threatening pulmonary complication occurring in patients with rare sickle-cell variants. Acute chest syndrome is characterized by a new pulmonary infiltrate on chest imaging accompanied by fever, chest pain, cough, or hypoxia, and is a leading cause of death in sickle-cell disease. This condition requires immediate hospitalization with aggressive hydration, pain management, transfusion support, and respiratory care.
Documentation Requirements
- ✓Document the specific sickle-cell variant along with chest imaging findings showing new pulmonary infiltrate.
- ✓Record presenting symptoms including fever, chest pain, dyspnea, cough, and oxygen saturation levels.
- ✓Include laboratory values such as hemoglobin, white blood cell count, and arterial blood gases.
- ✓Document any interventions including supplemental oxygen, exchange transfusion, antibiotics, and bronchodilators.
Commonly Confused Codes
- •D57.01 (Hemoglobin SS disease with acute chest syndrome) is used for homozygous sickle-cell disease specifically.
- •D57.211 (Sickle-cell/hemoglobin C disease with acute chest syndrome) applies when hemoglobin C is the second variant.
- •D57.411/D57.451 covers sickle-cell thalassemia variants with acute chest syndrome.
- •Simple pneumonia (J18.x) should not be used alone when acute chest syndrome is diagnosed in a sickle-cell patient.