Is D68.5 a billable ICD-10-CM code?

No. D68.5 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does D68.5 sit in the tabular list?

Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89), in the block Coagulation defects, purpura and other hemorrhagic conditions (D65-D69).

What cannot be coded together with D68.5?

D68.5 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

D68.5

D68.5 — Primary thrombophilia

Non-billable headerICD-10-CM

D68.5 is a non-billable header ICD-10-CM code for primary thrombophilia. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

antiphospholipid syndrome (D68.61)
lupus anticoagulant (D68.62)
secondary activated protein C resistance (D68.69)
secondary antiphospholipid antibody syndrome (D68.69)
secondary lupus anticoagulant with hypercoagulable state (D68.69)
secondary systemic lupus erythematosus [SLE] inhibitor with hypercoagulable state (D68.69)
systemic lupus erythematosus [SLE] inhibitor finding without diagnosis (R76.0)
systemic lupus erythematosus [SLE] inhibitor with hemorrhagic disorder (D68.312)
thrombotic thrombocytopenic purpura (M31.19)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Primary hypercoagulable states

Risk adjustment

D68.5 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Code to one of these instead D68.5

3 child codes. Green means billable.

Related codes at this level

Codes that share D68. If D68.5 is not quite right, the correct code is usually one of these.

Questions about D68.5

Is D68.5 a billable ICD-10-CM code?: No. D68.5 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does D68.5 sit in the tabular list?: Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89), in the block Coagulation defects, purpura and other hemorrhagic conditions (D65-D69).
What cannot be coded together with D68.5?: D68.5 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.