D68.61 ICD-10-CM Code: Antiphospholipid syndrome
D68.61 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · HCC Buddy coding tools
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FY 2026 Apr update / Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89) / Coagulation defects, purpura and other hemorrhagic conditions (D65-D69)
D68.61
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceAntiphospholipid syndrome
An autoimmune condition where the body produces antibodies that interfere with blood clotting, causing either excessive bleeding or clotting.
Buddy Insight
Antiphospholipid syndrome is an acquired systemic autoimmune thrombophilia characterized by vascular thrombosis (arterial or venous) and/or pregnancy morbidity in the presence of persistent antiphospholipid antibodies.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
MappedHCC 48
RAF 0.192
ACA/HHS
MappedHCC 75
Varies by metal level
ESRD/PACE
MappedHCC 48
RAF 0.063
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Anticardiolipin syndrome
- Antiphospholipid antibody syndrome
Excludes 2
Official- anti-phospholipid antibody with hemorrhagic disorder (D68.312)
- lupus anticoagulant syndrome (D68.62)
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for D68.61 in this effective period.
Excludes 1
Official- anti-phospholipid antibody, finding without diagnosis (R76.0)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for D68.61 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for D68.61 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for D68.61 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is D68.61 an HCC code?
Yes. D68.61 maps to Coagulation Defects and Other Specified Hematological Disorders under the V24 model but is not retained in V28.
- Code
- D68.61
- Description
- Antiphospholipid syndrome
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. 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.
Work D68.61 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for D68.61
For D68.61 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 D68.61 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
D68.61 is the ICD-10-CM diagnosis code for antiphospholipid syndrome. An autoimmune condition where the body produces antibodies that interfere with blood clotting, causing either excessive bleeding or clotting. D68.61 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, D68.61 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.
Document positive antiphospholipid antibody test results (anticardiolipin, anti-beta-2 glycoprotein, lupus anticoagulant). Because D68.61 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 D68.61 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document positive antiphospholipid antibody test results (anticardiolipin, anti-beta-2 glycoprotein, lupus anticoagulant)
- •Link to associated thrombotic or hemorrhagic events; this condition often coexists with lupus (SLE)
Clinical Significance
Antiphospholipid syndrome is an acquired systemic autoimmune thrombophilia characterized by vascular thrombosis (arterial or venous) and/or pregnancy morbidity in the presence of persistent antiphospholipid antibodies. It may be primary or secondary to systemic lupus erythematosus. Catastrophic antiphospholipid syndrome, involving multi-organ thrombosis, carries high mortality.
Documentation Requirements
- ✓Document positive antiphospholipid antibodies on two occasions at least 12 weeks apart (anticardiolipin IgG/IgM, anti-beta2 glycoprotein I IgG/IgM, or lupus anticoagulant), clinical criteria met (vascular thrombosis or pregnancy morbidity), and whether the condition is primary or secondary.
- ✓Record current anticoagulation regimen and target INR.
Excludes 1, Do NOT code together
- anti-phospholipid antibody, finding without diagnosis (R76.0)