D57.813
BillableOther sickle-cell disorders with cerebral vascular involvement
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D57.813 an HCC code?
Yes. D57.813 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 D57.813
For D57.813 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 D57.813 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D57.813 is the ICD-10-CM diagnosis code for other sickle-cell disorders with cerebral vascular involvement. A rare sickle-cell disorder with stroke or blood vessel problems affecting the brain. D57.813 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, D57.813 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, D57.813 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.
Cerebral vascular involvement is a serious complication; ensure imaging or clinical evidence supports this diagnosis. Because D57.813 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 D57.813 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Cerebral vascular involvement is a serious complication; ensure imaging or clinical evidence supports this diagnosis
- •Document whether this is a stroke, transient ischemic attack, or other cerebral vascular event
Clinical Significance
Other sickle-cell disorders with cerebral vascular involvement captures stroke or cerebrovascular events occurring in patients with rare sickle-cell variants. Sickle-cell disease is a major risk factor for both ischemic and hemorrhagic stroke, with cerebrovascular disease affecting up to 11% of sickle-cell patients by age 20. This condition may present as acute stroke, transient ischemic attack, or silent cerebral infarction, and requires urgent neurological evaluation and chronic transfusion therapy.
Documentation Requirements
- ✓Document the specific sickle-cell variant and the type of cerebrovascular event (ischemic stroke, hemorrhagic stroke, transient ischemic attack, or moyamoya disease).
- ✓Include neuroimaging results (magnetic resonance imaging, magnetic resonance angiography, or computed tomography).
- ✓Record neurological examination findings, National Institutes of Health Stroke Scale score if applicable, and any residual deficits.
- ✓Document treatment including exchange transfusion, chronic transfusion program, and hydroxyurea therapy.
Code Also
- , if applicable: cerebral infarction (I63.-)