ICD-10 D57.813
Billable / Specific HCC v28: 46 MCCOther sickle-cell disorders with cerebral vascular involvement
About ICD-10-CM D57.813
ICD-10-CM code D57.813 represents Other sickle-cell disorders with cerebral vascular involvement. This is a billable/specific code in the Blood and Blood-forming Organs chapter (block D57). The 2026 edition of ICD-10-CM D57.813 became effective on October 1, 2025.
Coding Tips for D57.813
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
D57.813 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.
D57.813 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.
Coding Notes
Code Also
- , if applicable: cerebral infarction (I63.-)
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 Other sickle-cell disorders with cerebral vascular involvement. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for D57.813
Local Coverage Determinations (LCDs) from CMS MACs that list D57.813 as a covered diagnosis.
Showing top 10 of 253 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing D57.813.
5 Medicare
CPT Codes Commonly Billed with D57.813
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
Codes Adjacent To D57.813
Other codes in section D55-D59 (Hemolytic anemias).
ICD-10 D57.813, Billing FAQ
Is ICD-10 code D57.813 billable? +
Yes, D57.813 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does D57.813 affect Medicare Advantage HCC risk adjustment? +
Yes. D57.813 maps to CMS-HCC v28 category 46. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is D57.813 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 D57.813? +
Procedures frequently paired with D57.813 include: 92235, 92240, 93895.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on July 16, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team