D69.1
BillableQualitative platelet defects
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D69.1 an HCC code?
Yes. D69.1 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 D69.1
For D69.1 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 D69.1 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D69.1 is the ICD-10-CM diagnosis code for qualitative platelet defects. A condition where platelets don't function properly even though the count is normal, leading to increased bleeding and bruising. D69.1 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, D69.1 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, D69.1 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 platelet count is normal or near-normal to distinguish from thrombocytopenia. Because D69.1 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 D69.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify the platelet count is normal or near-normal to distinguish from thrombocytopenia
- •Document the specific type of qualitative defect if identified (e.g., Glanzmann thrombasthenia, Bernard-Soulier syndrome)
Clinical Significance
Qualitative platelet defects encompass a group of inherited and acquired conditions where platelet number is normal but platelet function is impaired, leading to mucocutaneous bleeding. Examples include Glanzmann thrombasthenia (glycoprotein IIb/IIIa deficiency), Bernard-Soulier syndrome (glycoprotein Ib/IX/V deficiency), and storage pool diseases. These conditions cause prolonged bleeding time and abnormal platelet aggregation studies.
Documentation Requirements
- ✓Document the specific platelet function defect identified through aggregation studies, flow cytometry, or genetic testing.
- ✓Record platelet count (which is characteristically normal), bleeding time or PFA-100 closure times, and specific aggregation abnormalities (ristocetin, ADP, collagen, epinephrine).
- ✓Note whether the condition is inherited or acquired.
Excludes 1 — Do NOT code together
- hemolytic-uremic syndrome (D59.3-)
Excludes 2 — Not included here, may code separately
- von Willebrand disease (D68.0-)