D68.311
BillableAcquired hemophilia
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D68.311 an HCC code?
Yes. D68.311 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 D68.311
For D68.311 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 D68.311 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D68.311 is the ICD-10-CM diagnosis code for acquired hemophilia. A bleeding disorder that develops when the body produces antibodies against clotting factor VIII, preventing normal blood clotting. D68.311 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, D68.311 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, D68.311 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.
Confirm this is acquired (not congenital hemophilia A) and document the presence of factor VIII inhibitors. Because D68.311 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 D68.311 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm this is acquired (not congenital hemophilia A) and document the presence of factor VIII inhibitors
- •Note any associated conditions such as autoimmune disorders, malignancy, or recent factor VIII exposure that may have triggered antibody formation
Clinical Significance
Acquired hemophilia is a rare autoimmune disorder caused by spontaneous development of autoantibodies (inhibitors) against factor VIII, most commonly occurring in elderly patients, postpartum women, or in association with autoimmune diseases and malignancies. It presents with sudden-onset severe bleeding in a previously healthy individual, with a mortality rate of 9-22%. Unlike hereditary hemophilia, joint bleeding is uncommon while soft tissue and mucosal bleeding predominate.
Documentation Requirements
- ✓Document the presence of factor VIII inhibitor with titer level (Bethesda units), reduced factor VIII activity, prolonged aPTT that does not correct on mixing study, and underlying associated conditions.
- ✓Record the acute bleeding management strategy (bypassing agents such as FEIBA or rFVIIa) and immunosuppressive therapy used for inhibitor eradication.