D68.1
BillableHereditary factor XI deficiency
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D68.1 an HCC code?
Yes. D68.1 maps to Von Willebrand Disease and Other Coagulation Defects under the CMS-HCC V28 risk adjustment model (and Coagulation Defects and Other Specified Hematological Disorders under V24).
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 D68.1
For D68.1 to 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 D68.1 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D68.1 is the ICD-10-CM diagnosis code for hereditary factor xi deficiency. This is a rare inherited bleeding disorder where the body doesn't produce enough of a protein called factor XI, which is needed for blood to clot properly. People with this condition may experience excessive bleeding after injuries or surgery. D68.1 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 CMS-HCC V28 risk adjustment model, D68.1 maps to Von Willebrand Disease and Other Coagulation Defects (HCC 112) with a community, non-dual, aged base RAF weight of 0.247. Under the older CMS-HCC V24 model, D68.1 maps to Coagulation Defects and Other Specified Hematological Disorders (HCC 48) with a community, non-dual, aged base RAF weight of 0.209. 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.
Verify the diagnosis is specifically hereditary factor XI deficiency and not acquired factor XI deficiency (D68.4), as the distinction affects coding accuracy. Because D68.1 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 D68.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify the diagnosis is specifically hereditary factor XI deficiency and not acquired factor XI deficiency (D68.4), as the distinction affects coding accuracy
- •Document whether the patient has a personal or family history of this condition, as this hereditary disorder often requires genetic counseling documentation
Clinical Significance
Hereditary factor XI deficiency (Hemophilia C) is an autosomal bleeding disorder most commonly seen in Ashkenazi Jewish populations, with a prevalence of 1 in 450 in that group. Unlike Hemophilia A and B, bleeding severity does not correlate well with factor XI levels, and patients may be asymptomatic until challenged by surgery or trauma. Spontaneous bleeding is uncommon.
Documentation Requirements
- ✓Document factor XI activity level, bleeding history (particularly post-surgical or post-traumatic), and ethnic background when relevant.
- ✓Record whether the patient is heterozygous (partial deficiency) or homozygous/compound heterozygous (severe deficiency).
- ✓Note treatment history including fresh frozen plasma or factor XI concentrate use.
Commonly Confused Codes
- •D66 (Hemophilia A) and D67 (Hemophilia B) — more severe inherited bleeding disorders with different factor deficiencies
- •D68.2 (Hereditary deficiency of other clotting factors) — captures other rare factor deficiencies beyond VIII, IX, and XI
- •D68.311 (Acquired hemophilia) — autoimmune condition rather than inherited.