D57.454: Sickle-cell thalassemia beta plus with dactylitis

Risk adjustment

D57.454 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 108 Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major0.146 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

D57.454 is named in 15 Medicare coverage policies: 15 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A55717Billing and Coding: Lab: Flow Cytometry
• A56421Billing and Coding: CT of the Abdomen and Pelvis
• A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
• A56697Billing and Coding: Non-Invasive Vascular Studies