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v1.0.0
ICD-10 Guide
ICD-10 CodesD57.459

D57.459

Billable

Sickle-cell thalassemia beta plus with crisis, unspecified

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

Code Description

ICD-10 D57.459 is a billable code used to indicate a diagnosis of sickle-cell thalassemia beta plus with crisis, unspecified.

Key Diagnostic Point:

Sickle-cell thalassemia beta plus is a complex hemoglobinopathy resulting from the combination of sickle cell disease and beta-thalassemia. Patients with this condition have a mutation in the beta-globin gene, leading to the production of abnormal hemoglobin (HbS) and reduced production of normal hemoglobin (HbA). This results in a spectrum of clinical manifestations, including hemolytic anemia, vaso-occlusive crises, and increased susceptibility to infections. The term 'with crisis' indicates that the patient is experiencing an acute episode characterized by severe pain due to vaso-occlusion, which can affect various organs. The unspecified nature of the crisis indicates that the specific type or location of the crisis is not documented. Management typically involves pain control, hydration, and sometimes blood transfusions. Genetic counseling is also important for affected individuals and their families, as this condition is inherited in an autosomal recessive pattern. Understanding the interplay between sickle cell disease and thalassemia is crucial for effective treatment and management.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiation between types of sickle cell disease and thalassemia
  • Variability in clinical presentation and severity
  • Need for precise documentation of crises and complications
  • Genetic testing results and their implications

Audit Risk Factors

  • Inadequate documentation of crisis episodes
  • Failure to specify the type of crisis
  • Misclassification of sickle cell disease severity
  • Lack of genetic testing documentation

Specialty Focus

Medical Specialties

Hematology

Documentation Requirements

Detailed clinical history, laboratory results, and treatment plans must be documented.

Common Clinical Scenarios

Management of pain crises, blood transfusions, and monitoring for complications.

Billing Considerations

Ensure accurate representation of the patient's hemoglobin profile and crisis history.

Genetics

Documentation Requirements

Genetic testing results and family history must be clearly documented.

Common Clinical Scenarios

Counseling for families regarding inheritance patterns and risks.

Billing Considerations

Documentation should include the implications of genetic findings on treatment options.

Coding Guidelines

Inclusion Criteria

Use D57.459 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when the condition is confirmed and documented
  • Include any relevant complications or associated conditions in coding

Exclusion Criteria

Do NOT use D57.459 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

36430CPT Code

Transfusion, blood or blood components

Clinical Scenario

Used when a patient with sickle-cell thalassemia beta plus requires a blood transfusion due to severe anemia.

Documentation Requirements

Document the indication for transfusion and the patient's hemoglobin levels.

Specialty Considerations

Hematology specialists should ensure that the transfusion is justified based on clinical guidelines.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of hemoglobinopathies, improving the accuracy of patient records and facilitating better management of complex conditions like sickle-cell thalassemia beta plus.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of hemoglobinopathies, improving the accuracy of patient records and facilitating better management of complex conditions like sickle-cell thalassemia beta plus.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of hemoglobinopathies, improving the accuracy of patient records and facilitating better management of complex conditions like sickle-cell thalassemia beta plus.

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 the 'with crisis' designation?

The 'with crisis' designation indicates that the patient is experiencing an acute episode of pain or other complications related to their sickle-cell thalassemia beta plus, which requires specific management and documentation.