D68.62 ICD-10-CM Code: Lupus anticoagulant syndrome
HCC Buddy Code Card
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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)
D68.62
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceLupus anticoagulant syndrome
An autoimmune condition where antibodies against phospholipids interfere with blood clotting, paradoxically causing clots despite anticoagulant activity.
Buddy Insight
Lupus anticoagulant syndrome refers to the presence of lupus anticoagulant antibodies that paradoxically prolong in vitro clotting tests (aPTT) while predisposing to in vivo thrombosis.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
MappedHCC 48
RAF 0.209
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 48
RAF 0.0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Lupus anticoagulant
- Presence of systemic lupus erythematosus [SLE] inhibitor
Excludes 2
Official- anticardiolipin syndrome (D68.61)
- antiphospholipid syndrome (D68.61)
- lupus anticoagulant (LAC) with hemorrhagic disorder (D68.312)
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for D68.62 in this effective period.
Excludes 1
Official- lupus anticoagulant (LAC) finding without diagnosis (R76.0)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for D68.62 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for D68.62 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for D68.62 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is D68.62 an HCC code?
Yes. D68.62 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 D68.62
For D68.62to 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 D68.62 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
D68.62 is the ICD-10-CM diagnosis code for lupus anticoagulant syndrome. An autoimmune condition where antibodies against phospholipids interfere with blood clotting, paradoxically causing clots despite anticoagulant activity. D68.62 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, D68.62 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.
This is a specific type of antiphospholipid syndrome; document positive lupus anticoagulant test results. Because D68.62 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 D68.62 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a specific type of antiphospholipid syndrome; document positive lupus anticoagulant test results
- •Often associated with recurrent miscarriages and thrombosis; code related complications separately
Clinical Significance
Lupus anticoagulant syndrome refers to the presence of lupus anticoagulant antibodies that paradoxically prolong in vitro clotting tests (aPTT) while predisposing to in vivo thrombosis. Despite its name, it is not exclusive to lupus patients and can occur independently. The prolonged aPTT may cause confusion in perioperative or acute care settings where it could be mistaken for a bleeding risk.
Documentation Requirements
- ✓Document positive lupus anticoagulant on two occasions at least 12 weeks apart using validated assays (dilute Russell viper venom time, sensitive aPTT).
- ✓Record thrombotic history, association with SLE or other autoimmune conditions, and current anticoagulation management.
- ✓Note any confusion with bleeding risk due to prolonged aPTT.
Excludes 1, Do NOT code together
- lupus anticoagulant (LAC) finding without diagnosis (R76.0)