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

Excludes1 inherited from the categories above D68.5

A category’s note binds every code beneath it.

Written on D68: Other coagulation defects

abnormal coagulation profile NOS (R79.1)

Excludes2 inherited from the categories above D68.5

Not part of this code, but both may be coded when both are present.

Written on D68: Other coagulation defects

coagulation defects complicating abortion or ectopic or molar pregnancy (O00-O07, O08.1)
coagulation defects complicating pregnancy, childbirth and the puerperium (O45.0, O46.0, O67.0, O72.3)

Other codes that can never be billed with D68.5

Their own Excludes1 notes name this code, so the conflict is not listed above.

R79.1Abnormal coagulation profile

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Code history

Unchanged in every release from FY2024 to FY2027.

Code to one of these instead D68.5

3 child codes. Green means billable.