ICD-10 D57.431
Billable / Specific HCC v28: 46 MCCSickle-cell thalassemia beta zero with acute chest syndrome
About ICD-10-CM D57.431
ICD-10-CM code D57.431 represents Sickle-cell thalassemia beta zero with acute chest syndrome. This is a billable/specific code in the Blood and Blood-forming Organs chapter (block D57). The 2026 edition of ICD-10-CM D57.431 became effective on October 1, 2025.
Coding Tips for D57.431
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
D57.431 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.
D57.431 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 D57.431. Per CMS ICD-10-CM Tabular 2026.
- HbS-beta zero with acute chest syndrome
- Sickle-cell beta zero with acute chest syndrome
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 beta zero with acute chest syndrome. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for D57.431
Local Coverage Determinations (LCDs) from CMS MACs that list D57.431 as a covered diagnosis.
Showing top 10 of 342 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing D57.431.
5 Medicare
CPT Codes Commonly Billed with D57.431
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
Codes Adjacent To D57.431
Other codes in section D55-D59 (Hemolytic anemias).
ICD-10 D57.431, Billing FAQ
Is ICD-10 code D57.431 billable? +
Yes, D57.431 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 D57.431? +
ICD-10 D57.431 includes: HbS-beta zero with acute chest syndrome; Sickle-cell beta zero with acute chest syndrome.
Does D57.431 affect Medicare Advantage HCC risk adjustment? +
Yes. D57.431 maps to CMS-HCC v28 category 46. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is D57.431 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 D57.431? +
Procedures frequently paired with D57.431 include: 93895.
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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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