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D57.811 ICD-10-CM Code: Other sickle-cell disorders with acute chest syndrome

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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)

D57.811

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

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.

Buddy the Bee presenting code insight

Buddy Insight

Other sickle-cell disorders with acute chest syndrome represents a life-threatening pulmonary complication occurring in patients with rare sickle-cell variants.

CMS-HCC V28

HCC 108

RAF 0.146

CMS-HCC V24

HCC 46

RAF 1.372

ACA/HHS

HCC 71

Varies by metal level

ESRD/PACE

HCC 46

RAF 0.223

RXHCC

N/A

—

Not mapped

Code Book Path

Official
D57.8Other sickle-cell disorders
D57.81Other sickle-cell disorders with crisis
D57.811Other sickle-cell disorders with acute chest syndrome

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for D57.811 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for D57.811 in this effective period.

Related Child Codes

Official
D57.812Other sickle-cell disorders with splenic sequestration
D57.813Other sickle-cell disorders with cerebral vascular involvement
D57.814Other sickle-cell disorders with dactylitis
D57.818Other sickle-cell disorders with crisis with other specified complication
D57.819Other sickle-cell disorders with crisis, unspecified

Includes

Official

ICD-10-CM does not list Includes notes for D57.811 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for D57.811 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for D57.811 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for D57.811 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for D57.811 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
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.

MEAT Support

HCC Buddy guidance
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.

Audit Caution

HCC Buddy guidance
Acute chest syndrome is not the same as simple pneumonia -
when a sickle-cell patient develops pulmonary infiltrates, the provider should clarify whether acute chest syndrome is present. Do not code this without radiographic evidence of pulmonary infiltrate. Ensure the sickle-cell variant is truly an 'other' type not covered by more specific D57 subcategories.

Common Mistakes

HCC Buddy guidance
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.

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 D57.811 an HCC code?

Yes. D57.811 (Other sickle-cell disorders with acute chest syndrome) maps to Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major under the CMS-HCC V28 risk adjustment model (and Severe Hematological Disorders under V24), with a community non-dual aged RAF of 0.146. It is billable for payment year 2026.

Coder answer: D57.811 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
D57.811
Description
Other sickle-cell disorders with acute chest syndrome
HCC (V28)
HCC 108 — Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major
RAF
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
V24HCC 46, Severe Hematological Disorders
1.372
ESRDHCC 46, Severe Hematological Disorders
0.223

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work D57.811 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

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.

Coder workflow notes

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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, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major (HCC 108) with a community, non-dual, aged base RAF weight of 0.146. 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 1.372. 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.

Child Codes

D57.811Other sickle-cell disorders with acute chest syndrome
HCC 108
D57.812Other sickle-cell disorders with splenic sequestration
HCC 108
D57.813Other sickle-cell disorders with cerebral vascular involvement
HCC 108
D57.814Other sickle-cell disorders with dactylitis
HCC 108
D57.818Other sickle-cell disorders with crisis with other specified complication
HCC 108
D57.819Other sickle-cell disorders with crisis, unspecified
HCC 108

Code Hierarchy

└D57Sickle-cell disorders└D57.8Other sickle-cell disorders└D57.81Other sickle-cell disorders with crisis└D57.811Other sickle-cell disorders with acute chest syndrome
└D57.811Other sickle-cell disorders with acute chest syndrome

Because D57.811 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

D57.811 maps to CMS-HCC V28 category 108, Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. Because D57.811 carries a payment HCC, you can see what it adds to a RAF score and check the documentation the chart needs before it is submitted.

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