ICD-10 Coding for Thrombophilia(D68.59, D68.69)
Complete ICD-10-CM coding and documentation guide for Thrombophilia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Thrombophilia
D68.5-D68.69Primary Range
Other coagulation defects
This range includes codes for primary and secondary thrombophilia, which are essential for documenting genetic and acquired hypercoagulable states.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| D68.59 | Other primary thrombophilia | Use when thrombophilia is confirmed by genetic testing and is the primary focus of care. |
|
| D68.69 | Other secondary thrombophilia | Use when thrombophilia is secondary to another condition, such as cancer or surgery. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for hereditary thrombophilia
Essential facts and insights about Thrombophilia
Primary ICD-10-CM Codes for thrombophilia
Decision Criteria
clinical Criteria
- Genetic confirmation of thrombophilia
Applicable To
- Hereditary thrombophilia
- Factor V Leiden mutation
- Prothrombin gene mutation
Excludes
- Antiphospholipid syndrome (D68.61)
Clinical Validation Requirements
- Genetic test confirming mutation
- Family history of venous thromboembolism
- Age <50 at first clot
Code-Specific Risks
- Coding without confirmatory genetic testing
Coding Notes
- Ensure genetic confirmation is documented in the patient's medical record.
D68.69 - Other secondary thrombophilia
Use when thrombophilia is secondary to another condition, such as cancer or surgery.
Applicable To
- Acquired hypercoagulable state
- Thrombophilia due to malignancy
Excludes
- Thrombophilia in pregnancy (O22.5-)
Clinical Validation Requirements
- Temporal relationship to risk factor
- Negative genetic thrombophilia panel
Coding Notes
Document the underlying condition clearly to support the use of this code.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Long-term (current) use of anticoagulants
Z79.01Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Thrombophilia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code D68.59.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims due to insufficient documentation.
Mitigation Strategy
Ensure genetic test results are included in the patient's record., Educate staff on documentation requirements for thrombophilia.
Impact
Reimbursement: May lead to incorrect DRG assignment and reimbursement issues., Compliance: Non-compliance with coding guidelines., Data Quality: Impacts accuracy of patient records and data analytics.
Mitigation Strategy
Clarify if thrombophilia is hereditary (D68.59) or acquired (D68.69) in documentation.
Impact
Failure to specify hereditary or acquired thrombophilia can lead to audit issues.
Mitigation Strategy
Implement documentation checks to ensure type is specified.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Thrombophilia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Thrombophilia
Use these documentation templates to ensure complete and accurate documentation for Thrombophilia. These templates include all required elements for proper coding and billing.
Patient with hereditary thrombophilia
Specialty: HematologyRequired Elements
- Type of thrombophilia
- Genetic test results
- Family history
- Anticoagulation therapy
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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