D68.69 ICD-10-CM Code: Other thrombophilia
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
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)
D68.69
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther thrombophilia
Other autoimmune or acquired conditions affecting blood clotting that increase clot formation risk, not classified elsewhere.
Buddy Insight
Other thrombophilia captures acquired or secondary thrombophilic states not classified elsewhere, including hyperhomocysteinemia-associated thrombophilia, nephrotic syndrome-related hypercoagulability, malignancy-associated thrombophilia, and elevated factor VIII levels associated with thrombotic risk.
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- COVID-19 associated hypercoagulability
- Hypercoagulable states NEC
- Secondary hypercoagulable state NOS
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for D68.69 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for D68.69 in this effective period.
Excludes 1
Official- diffuse or disseminated intravascular coagulation [DIC] (D65)
- heparin induced thrombocytopenia (HIT) (D75.82-)
- hyperhomocysteinemia (E72.11)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for D68.69 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for D68.69 in this effective period.
Code Also
Official- , if applicable, associated condition
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 D68.69 an HCC code?
Yes. D68.69 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.
Work D68.69 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for D68.69
For D68.69to 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 D68.69 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
D68.69 is the ICD-10-CM diagnosis code for other thrombophilia. Other autoimmune or acquired conditions affecting blood clotting that increase clot formation risk, not classified elsewhere. D68.69 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, D68.69 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.
Use this code for thrombophilias secondary to autoimmune conditions or other acquired causes not specifically listed. Because D68.69 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 D68.69 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code for thrombophilias secondary to autoimmune conditions or other acquired causes not specifically listed
- •Document the underlying autoimmune condition (e.g., SLE, antiphospholipid syndrome variants) for complete coding
Clinical Significance
Other thrombophilia captures acquired or secondary thrombophilic states not classified elsewhere, including hyperhomocysteinemia-associated thrombophilia, nephrotic syndrome-related hypercoagulability, malignancy-associated thrombophilia, and elevated factor VIII levels associated with thrombotic risk. These conditions represent a heterogeneous group of prothrombotic states requiring individualized management.
Documentation Requirements
- ✓Document the specific underlying thrombophilic condition, laboratory evidence supporting the diagnosis (homocysteine levels, factor VIII levels, coagulation studies), personal thrombotic history, and current treatment or prophylaxis strategy.
- ✓Record the underlying cause if secondary (malignancy, nephrotic syndrome).
Code Also
- , if applicable, associated condition