D65
BillableDisseminated intravascular coagulation [defibrination syndrome]
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D65 an HCC code?
Yes. D65 maps to Coagulation Defects and Other Specified Hematological Disorders under the V24 model but is not retained in V28.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for D65
For D65to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed D65 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D65 is the ICD-10-CM diagnosis code for disseminated intravascular coagulation [defibrination syndrome]. A serious condition where blood clots form throughout the body while simultaneously bleeding occurs due to consumption of clotting factors. D65 sits in the ICD-10-CM chapter for diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (d50-d89), within the section covering coagulation defects, purpura and other hemorrhagic conditions (d65-d69).
Under the older CMS-HCC V24 model, D65 maps to Coagulation Defects and Other Specified Hematological Disorders (HCC 48) with a community, non-dual, aged base RAF weight of 0.192. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Always identify and code the underlying cause (sepsis, trauma, malignancy, etc.). Because D65 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for D65 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Always identify and code the underlying cause (sepsis, trauma, malignancy, etc.)
- •This is often an acute, life-threatening condition requiring immediate intervention
Clinical Significance
Disseminated intravascular coagulation is a life-threatening condition involving systemic activation of the coagulation cascade, leading to simultaneous widespread thrombosis and hemorrhage. It is always secondary to an underlying trigger such as sepsis, malignancy, trauma, or obstetric complications. Prompt identification and treatment of the underlying cause is critical, as DIC carries significant mortality.
Documentation Requirements
- ✓Document the underlying etiology triggering the DIC (sepsis, malignancy, trauma, obstetric emergency).
- ✓Record laboratory findings including platelet count, fibrinogen level, D-dimer, PT/INR, PTT, and fibrin degradation products.
- ✓Note whether the presentation is acute (hemorrhagic) or chronic (thrombotic), along with any end-organ damage.
Excludes 1 — Do NOT code together
Code Also
- , if applicable, associated condition
Commonly Confused Codes
- •D68.32 (Hemorrhagic disorder due to extrinsic circulating anticoagulants) — anticoagulant-related bleeding without systemic coagulation activation
- •D68.8 (Other specified coagulation defects) — lacks the consumptive coagulopathy hallmark
- •D69.6 (Thrombocytopenia, unspecified) — isolated low platelets without the full DIC picture.