ICD-10 D57.419
Billable / Specific HCC v28: 46 MCCSickle-cell thalassemia, unspecified, with crisis
About ICD-10-CM D57.419
ICD-10-CM code D57.419 represents Sickle-cell thalassemia, unspecified, with crisis. This is a billable/specific code in the Blood and Blood-forming Organs chapter (block D57). The 2026 edition of ICD-10-CM D57.419 became effective on October 1, 2025.
Coding Tips for D57.419
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
D57.419 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.
D57.419 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.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under D57.419. Per CMS ICD-10-CM Tabular 2026.
- Sickle-cell thalassemia with (painful) crisis NOS
- Sickle-cell thalassemia with (vaso-occlusive) pain NOS
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 Sickle-cell thalassemia, unspecified, with crisis. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for D57.419
Local Coverage Determinations (LCDs) from CMS MACs that list D57.419 as a covered diagnosis.
Showing top 10 of 150 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing D57.419.
5 Medicare
1 Aetna
CPT Codes Commonly Billed with D57.419
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 93895 CMS LCD: Billing and Coding: Non-Invasive Cerebrovascular Studies CMS LCD
Convert D57.419 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 |
|---|---|---|
| D57.419 | 28242 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To D57.419
Other codes in section D55-D59 (Hemolytic anemias).
ICD-10 D57.419, Billing FAQ
Is ICD-10 code D57.419 billable? +
Yes, D57.419 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to D57.419? +
ICD-10 D57.419 includes: Sickle-cell thalassemia with (painful) crisis NOS; Sickle-cell thalassemia with (vaso-occlusive) pain NOS.
Does D57.419 affect Medicare Advantage HCC risk adjustment? +
Yes. D57.419 maps to CMS-HCC v28 category 46. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is D57.419 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 D57.419? +
Procedures frequently paired with D57.419 include: 93895.
What ICD-9 codes does D57.419 map to? +
Per CMS GEMs, D57.419 maps to ICD-9 codes: 28242. 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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