D57.812
BillableOther sickle-cell disorders with splenic sequestration
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D57.812 an HCC code?
Yes. D57.812 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 D57.812
For D57.812 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 D57.812 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D57.812 is the ICD-10-CM diagnosis code for other sickle-cell disorders with splenic sequestration. A rare sickle-cell disorder with splenic sequestration, where blood becomes trapped in the spleen causing organ enlargement and anemia. D57.812 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, D57.812 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, D57.812 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.
Splenic sequestration is a medical emergency in children; verify documentation of spleen involvement and hemoglobin drop. Because D57.812 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 D57.812 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Splenic sequestration is a medical emergency in children; verify documentation of spleen involvement and hemoglobin drop
- •This complication requires urgent medical intervention and should be clearly documented
Clinical Significance
Other sickle-cell disorders with splenic sequestration describes a medical emergency in rare sickle-cell variants where sickled red blood cells become trapped in the spleen, causing rapid splenic enlargement, severe anemia, and potentially fatal hypovolemic shock. This complication is most common in young children before autosplenectomy occurs and can progress rapidly from onset to cardiovascular collapse. Immediate transfusion and potentially emergent splenectomy may be required.
Documentation Requirements
- ✓Document the specific sickle-cell variant and evidence of splenic enlargement on physical examination or imaging.
- ✓Record hemoglobin drop from baseline (typically a decrease of 2 g/dL or more), platelet count, and reticulocyte count.
- ✓Include vital signs demonstrating hemodynamic stability or instability.
- ✓Document any transfusion therapy administered, fluid resuscitation, and whether splenectomy was performed or planned.