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v1.0.0
ICD-10 Guide
ICD-10 CodesD68.6

D68.6

Billable

Other thrombophilia

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 D68.6 is a billable code used to indicate a diagnosis of other thrombophilia.

Key Diagnostic Point:

Other thrombophilia refers to a group of conditions characterized by an increased tendency to form blood clots due to various coagulation defects that do not fall under the more common categories of thrombophilia, such as Factor V Leiden or prothrombin gene mutation. These conditions may include deficiencies in proteins involved in the coagulation cascade, such as antithrombin, protein C, or protein S, as well as other rare inherited or acquired disorders. Patients with other thrombophilia may present with recurrent venous thromboembolism (VTE), arterial thrombosis, or complications during pregnancy, such as placental abruption or fetal loss. The diagnosis often requires a thorough clinical evaluation, including family history, laboratory tests to assess coagulation factors, and sometimes genetic testing. Management may involve anticoagulation therapy, lifestyle modifications, and monitoring for thrombotic events. Accurate coding is essential for appropriate treatment and reimbursement, as well as for tracking epidemiological data related to these conditions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes leading to thrombophilia.
  • Need for comprehensive patient history and laboratory results.
  • Differentiation from other coagulation disorders.
  • Potential for overlapping symptoms with bleeding disorders.

Audit Risk Factors

  • Inadequate documentation of laboratory results.
  • Failure to specify the underlying cause of thrombophilia.
  • Misclassification of thrombophilia type.
  • Lack of clear clinical rationale for anticoagulation therapy.

Specialty Focus

Medical Specialties

Hematology

Documentation Requirements

Detailed lab results, family history, and treatment plans.

Common Clinical Scenarios

Patients presenting with recurrent thrombosis or unexplained bleeding.

Billing Considerations

Ensure all relevant coagulation tests are documented to support the diagnosis.

Obstetrics

Documentation Requirements

Pregnancy history, complications, and management plans.

Common Clinical Scenarios

Pregnant patients with a history of thrombosis or recurrent pregnancy loss.

Billing Considerations

Document any anticoagulation therapy and its indications during pregnancy.

Coding Guidelines

Inclusion Criteria

Use D68.6 When
  • According to ICD
  • 10 coding guidelines, D68
  • 6 should be used when the specific type of thrombophilia is not classified elsewhere
  • Coders must ensure that the diagnosis is supported by clinical documentation and laboratory findings
  • It is important to differentiate between inherited and acquired forms of thrombophilia when applicable

Exclusion Criteria

Do NOT use D68.6 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

85610CPT Code

Prothrombin time (PT)

Clinical Scenario

Used to monitor anticoagulation therapy in patients with thrombophilia.

Documentation Requirements

Document the indication for the test and the patient's anticoagulation status.

Specialty Considerations

Hematologists should ensure that all relevant coagulation tests are included in the patient's record.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of thrombophilia, enabling better tracking of these conditions and their management. D68.6 provides a broader category for less common thrombophilic disorders, improving the granularity of data collected for epidemiological studies.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of thrombophilia, enabling better tracking of these conditions and their management. D68.6 provides a broader category for less common thrombophilic disorders, improving the granularity of data collected for epidemiological studies.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of thrombophilia, enabling better tracking of these conditions and their management. D68.6 provides a broader category for less common thrombophilic disorders, improving the granularity of data collected for epidemiological studies.

Resources

Clinical References

  • •
    American Society of Hematology

Coding & Billing References

  • •
    American Society of Hematology

Frequently Asked Questions

What is the difference between D68.6 and other thrombophilia codes?

D68.6 is used for thrombophilia that does not fit into more specific categories, such as antiphospholipid syndrome or hereditary factor deficiencies. It captures a range of conditions that increase the risk of thrombosis.