ICD-10 D57.02
Billable / Specific HCC v28: 46 MCCHb-SS disease with splenic sequestration
About ICD-10-CM D57.02
ICD-10-CM code D57.02 represents Hb-SS disease with splenic sequestration. This is a billable/specific code in the Blood and Blood-forming Organs chapter (block D57). The 2026 edition of ICD-10-CM D57.02 became effective on October 1, 2025.
Coding Tips for D57.02
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
D57.02 is a CMS-HCC v28 risk-adjustment code (category 46). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
D57.02 is designated MCC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-MCC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag MCC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, MCC
codes Hb-SS disease with splenic sequestration. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for D57.02
Local Coverage Determinations (LCDs) from CMS MACs that list D57.02 as a covered diagnosis.
Showing top 10 of 293 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing D57.02.
5 Medicare
CPT Codes Commonly Billed with D57.02
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 92235 CMS LCD: Billing and Coding: Ophthalmic Angiography (Fluorescein and Indocyanine Green) CMS LCD
- 92240 CMS LCD: Billing and Coding: Ophthalmic Angiography (Fluorescein and Indocyanine Green) CMS LCD
- 92242 CMS LCD: Billing and Coding: Ophthalmic Angiography (Fluorescein and Indocyanine Green) CMS LCD
- 92228 CMS LCD: Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography) CMS LCD
- 92201 CMS LCD: Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography) CMS LCD
- 92202 CMS LCD: Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography) CMS LCD
- 92250 CMS LCD: Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography) CMS LCD
- 92227 CMS LCD: Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography) CMS LCD
- J2791 CMS LCD: Billing and Coding: Intravenous Immunoglobulin (IVIG) CMS LCD
- J2792 CMS LCD: Billing and Coding: Intravenous Immunoglobulin (IVIG) CMS LCD
Convert D57.02 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| D57.02 | 28262 | 10111 |
| D57.02 | 28952 | 10112 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To D57.02
Other codes in section D55-D59 (Hemolytic anemias).
ICD-10 D57.02, Billing FAQ
Is ICD-10 code D57.02 billable? +
Yes, D57.02 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does D57.02 affect Medicare Advantage HCC risk adjustment? +
Yes. D57.02 maps to CMS-HCC v28 category 46. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is D57.02 a CC or MCC for inpatient DRG? +
Yes, this code is designated as MCC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with D57.02? +
Procedures frequently paired with D57.02 include: 92235, 92240, 92242, 92228, 92201.
What ICD-9 codes does D57.02 map to? +
Per CMS GEMs, D57.02 maps to ICD-9 codes: 28262, 28952. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on July 16, 2026.
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