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v1.0.0
ICD-10 Guide
ICD-10 CodesD57.438

D57.438

Billable

Sickle-cell thalassemia beta zero with crisis with other specified complication

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 D57.438 is a billable code used to indicate a diagnosis of sickle-cell thalassemia beta zero with crisis with other specified complication.

Key Diagnostic Point:

Sickle-cell thalassemia beta zero is a genetic blood disorder characterized by the presence of both sickle cell disease and beta-thalassemia. This condition leads to the production of abnormal hemoglobin, which can cause red blood cells to become rigid and sickle-shaped, leading to hemolytic anemia. Patients often experience painful crises due to vaso-occlusive events, where sickled cells obstruct blood flow in small vessels. The 'with crisis' designation indicates that the patient is currently experiencing an acute episode, which may be accompanied by other specified complications such as infections, acute chest syndrome, or splenic sequestration. Management typically involves pain control, hydration, and sometimes blood transfusions. Genetic factors play a significant role in the severity of the disease, as the presence of beta-thalassemia can modify the clinical course of sickle cell disease, potentially leading to a milder or more severe phenotype depending on the specific mutations present.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Combination of two genetic disorders (sickle cell disease and beta-thalassemia)
  • Variability in clinical presentation and complications
  • Need for precise documentation of crisis and complications
  • Potential for overlapping symptoms with other hemolytic anemias

Audit Risk Factors

  • Inadequate documentation of crisis events
  • Failure to specify complications
  • Misinterpretation of genetic testing results
  • Inconsistent coding of related conditions

Specialty Focus

Medical Specialties

Hematology

Documentation Requirements

Detailed patient history, genetic testing results, and documentation of crisis events.

Common Clinical Scenarios

Management of acute sickle cell crises, monitoring for complications, and coordinating care with other specialties.

Billing Considerations

Ensure that all complications are documented clearly to support the use of this specific code.

Genetics

Documentation Requirements

Genetic testing results, family history of hemoglobinopathies, and detailed patient counseling notes.

Common Clinical Scenarios

Counseling patients on genetic risks, interpreting genetic tests, and managing hereditary conditions.

Billing Considerations

Documentation must clearly outline the genetic basis of the condition to support coding.

Coding Guidelines

Inclusion Criteria

Use D57.438 When
  • Follow the ICD
  • CM coding guidelines for hemolytic anemias and genetic disorders
  • Ensure that the documentation supports the diagnosis of both sickle cell disease and beta
  • thalassemia, including any acute crises and complications

Exclusion Criteria

Do NOT use D57.438 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

36430CPT Code

Transfusion, blood or blood components

Clinical Scenario

Used during acute crises requiring blood transfusions.

Documentation Requirements

Document the need for transfusion due to anemia or crisis.

Specialty Considerations

Hematology specialists should ensure that transfusion protocols are followed.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of complex conditions like sickle-cell thalassemia beta zero, improving the accuracy of patient records and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of complex conditions like sickle-cell thalassemia beta zero, improving the accuracy of patient records and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    CDC Sickle Cell Disease

Coding & Billing References

  • •
    CDC Sickle Cell Disease

Frequently Asked Questions

What is the significance of the 'with crisis' designation?

The 'with crisis' designation indicates that the patient is currently experiencing an acute episode related to their sickle-cell thalassemia, which can significantly impact treatment and management strategies.