ICD-10 Code D57.454 | Sickle-cell thalassemia beta plus with dactylitis Symptoms, Diagnosis, Billing

Sickle-cell thalassemia beta plus with dactylitis is a genetic blood disorder characterized by the presence of both sickle cell disease and beta-thalassemia. This condition leads to abnormal hemoglobin production, resulting in sickle-shaped red blood cells that can cause vaso-occlusive crises and dactylitis, which is painful swelling of the fingers and toes. Accurate coding with ICD-10 Code D57.454 is essential for proper diagnosis, documentation, medical billing, and public health reporting, ensuring that patients receive appropriate care and resources.

What is ICD-10 Code D57.454 for Sickle-cell thalassemia beta plus with dactylitis?

ICD-10 Code D57.454 specifically denotes Sickle-cell thalassemia beta plus with dactylitis, a condition that combines features of sickle cell disease and beta-thalassemia. This code should be used when documenting cases where patients present with dactylitis as a complication of their underlying hemoglobinopathy, ensuring accurate representation of the patient's clinical status for billing and treatment purposes.

ICD-10 Code D57.454 – Clinical Definition and Explanation of Sickle-cell thalassemia beta plus with dactylitis

Sickle-cell thalassemia beta plus with dactylitis arises from mutations affecting hemoglobin production, leading to sickle-shaped erythrocytes that obstruct blood flow and cause pain. This condition necessitates medical attention due to its potential complications, including severe pain episodes and increased risk of infections.

Key Clinical Features:

• Dactylitis, characterized by painful swelling of fingers and toes.
• Vaso-occlusive crises leading to acute pain episodes.
• Increased susceptibility to infections due to splenic dysfunction.
• Anemia resulting from hemolysis of sickle cells.
• Potential for chronic complications affecting multiple organ systems.

ICD-10 Code D57.454 for Sickle-cell thalassemia beta plus with dactylitis – SOAP Notes & Clinical Use

ICD-10 Code D57.454 is utilized in SOAP notes to document the patient's symptoms, assessment findings, and treatment plans related to Sickle-cell thalassemia beta plus with dactylitis. This code is relevant in both acute and chronic care settings, facilitating comprehensive patient management.

What Does ICD-10 Code D57.454 for Sickle-cell thalassemia beta plus with dactylitis Mean in SOAP Notes?

In SOAP notes, ICD-10 Code D57.454 connects subjective patient-reported symptoms and objective clinical findings to a formal diagnosis of Sickle-cell thalassemia beta plus with dactylitis. This ensures continuity of care, supports accurate billing, and meets EHR documentation standards.

Treatment Options for ICD-10 Code D57.454 – Sickle-cell thalassemia beta plus with dactylitis

Management of Sickle-cell thalassemia beta plus with dactylitis requires a multifaceted approach, often necessitating hospitalization for severe cases.

Antibiotic Therapy:

• First-line: Penicillin prophylaxis for children until age 5.
• Alternative: Amoxicillin for patients with penicillin allergy.
• Duration: Continuous prophylaxis until age 5 or longer if indicated.

Supportive Care:

• Hydration to prevent vaso-occlusive crises.
• Pain management with NSAIDs or opioids as needed.
• Regular blood transfusions to manage anemia.

Infection Control:

• Vaccination against pneumococcus, meningococcus, and influenza.
• Prompt treatment of infections to prevent complications.
• Education on recognizing signs of infection.

How to Document Symptoms of Sickle-cell thalassemia beta plus with dactylitis (ICD-10 D57.454) in SOAP Notes

Subjective:

• Patient reports episodes of severe pain in hands and feet.
• History of recurrent infections and hospitalizations.
• Complaints of fatigue and weakness.

Objective:

• Swelling and tenderness noted in fingers and toes.
• Hemoglobin level: Low, indicating anemia.
• Vital signs: Elevated heart rate and temperature.

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SOAP Note Guidelines for Diagnosing Sickle-cell thalassemia beta plus with dactylitis (ICD-10 Code D57.454)

Assessment:

• Diagnosis: Sickle-cell thalassemia beta plus with dactylitis, moderate severity.
• ICD-10 Subcode: D57.454.
• Triggers: Recent infection and dehydration.

Plan:

• Initiate hydration therapy and pain management.
• Schedule regular follow-up for blood transfusions.
• Educate patient on recognizing symptoms of infection.

Treatment & Plan Section for ICD-10 Code D57.454 – Sickle-cell thalassemia beta plus with dactylitis

• First-line pharmacologic treatments include analgesics for pain relief.
• Non-pharmacologic strategies involve hydration and rest during crises.
• Monitoring includes regular hemoglobin checks and infection surveillance.
• Follow-up practices should include routine assessments for complications.

Using ICD-10 Code D57.454 for Sickle-cell thalassemia beta plus with dactylitis in Billing & SOAP Note Compliance

• Select accurate subcodes based on clinical severity or complications.
• Document symptoms clearly under Subjective (S) and Objective (O) in SOAP notes.
• Ensure treatment plans align with clinical guidelines to support justified billing.
• Commonly billed CPT codes include those for lab tests and consultations.

Related ICD-10 Codes Often Used with Sickle-cell thalassemia beta plus with dactylitis

• D57.1 – Sickle-cell disease without crisis
• D56.9 – Thalassemia, unspecified

ICD-10 Code D57.454 in Medical Billing and Insurance for Sickle-cell thalassemia beta plus with dactylitis

ICD-10 Code D57.454 is crucial for accurate billing in hospital, ER, or infectious disease care settings.

Billing Notes:

• Ensure documentation includes detailed patient history and clinical findings.
• Use this code in conjunction with relevant CPT codes for comprehensive billing.
• Highlight any complications or comorbidities in the medical record.

Common CPT Pairings: