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ICD-10 Guide
ICD-10 CodesD57.01

D57.01

Billable

Hb-SS disease with acute chest syndrome

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

Code Description

ICD-10 D57.01 is a billable code used to indicate a diagnosis of hb-ss disease with acute chest syndrome.

Key Diagnostic Point:

Hb-SS disease, also known as sickle cell disease, is a genetic blood disorder characterized by the presence of hemoglobin S (HbS), which causes red blood cells to become rigid and sickle-shaped. This abnormal shape leads to various complications, including hemolytic anemia, vaso-occlusive crises, and acute chest syndrome (ACS). ACS is a severe complication of sickle cell disease, presenting with chest pain, fever, cough, and respiratory distress, often due to pulmonary infarction or infection. The pathophysiology involves sickling of red blood cells in the pulmonary vasculature, leading to impaired oxygenation and inflammation. Patients with Hb-SS disease are at increased risk for infections, particularly from encapsulated organisms, due to splenic dysfunction. Management of ACS typically involves supportive care, pain management, and sometimes blood transfusions or hydroxyurea therapy. Accurate coding of D57.01 is crucial for proper reimbursement and tracking of healthcare outcomes related to this serious condition.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Requires understanding of genetic factors and pathophysiology of sickle cell disease.
  • Differentiation between acute chest syndrome and other respiratory conditions.
  • Need for precise documentation of symptoms and treatment interventions.
  • Potential for co-morbid conditions that may complicate coding.

Audit Risk Factors

  • Inadequate documentation of acute symptoms.
  • Failure to document the underlying sickle cell disease.
  • Misclassification of acute chest syndrome as pneumonia or other respiratory conditions.
  • Lack of evidence for treatment interventions provided.

Specialty Focus

Medical Specialties

Hematology

Documentation Requirements

Detailed patient history, laboratory results, and treatment plans.

Common Clinical Scenarios

Management of sickle cell crises, blood transfusions, and complications like ACS.

Billing Considerations

Need for comprehensive documentation of genetic testing and patient education.

Pulmonology

Documentation Requirements

Pulmonary function tests, imaging studies, and treatment responses.

Common Clinical Scenarios

Evaluation and management of respiratory symptoms in sickle cell patients.

Billing Considerations

Documentation of acute respiratory distress and differentiation from other lung diseases.

Coding Guidelines

Inclusion Criteria

Use D57.01 When
  • According to ICD
  • 10 guidelines, D57
  • 01 should be used when a patient with Hb
  • SS disease presents with acute chest syndrome
  • Documentation must clearly indicate the acute nature of the symptoms and any relevant treatments provided

Exclusion Criteria

Do NOT use D57.01 When
  • Exclusion criteria include other types of sickle cell disease without acute chest syndrome

Related ICD-10 Codes

Related CPT Codes

36430CPT Code

Transfusion, blood or blood components

Clinical Scenario

Used when a patient with Hb-SS disease requires a blood transfusion due to acute chest syndrome.

Documentation Requirements

Document the indication for transfusion and the patient's response.

Specialty Considerations

Hematology specialists should ensure compliance with transfusion protocols.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of sickle cell disease and its complications, improving data accuracy and patient care tracking. D57.01 provides a clear distinction for acute chest syndrome, which was less specific in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of sickle cell disease and its complications, improving data accuracy and patient care tracking. D57.01 provides a clear distinction for acute chest syndrome, which was less specific in ICD-9.

Reimbursement & Billing Impact

reimbursement and quality reporting.

Resources

Clinical References

  • •
    Sickle Cell Disease Association of America

Coding & Billing References

  • •
    Sickle Cell Disease Association of America

Frequently Asked Questions

What is the significance of coding D57.01?

Coding D57.01 is crucial for identifying patients with Hb-SS disease who experience acute chest syndrome, allowing for appropriate management and tracking of healthcare outcomes.