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ICD-10 Guide
ICD-10 CodesD69.4

D69.4

Billable

Other primary thrombocytopenia

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

Code Description

ICD-10 D69.4 is a billable code used to indicate a diagnosis of other primary thrombocytopenia.

Key Diagnostic Point:

Other primary thrombocytopenia refers to a condition characterized by a low platelet count (thrombocytopenia) that is not attributable to secondary causes such as medications, infections, or other underlying diseases. This condition can lead to increased bleeding risk due to insufficient platelet levels necessary for normal clotting. Patients may present with symptoms such as easy bruising, prolonged bleeding from cuts, and petechiae. The etiology of primary thrombocytopenia can include inherited disorders affecting platelet production or function, as well as acquired conditions that disrupt normal hematopoiesis. Diagnosis typically involves a thorough clinical evaluation, complete blood count (CBC), and possibly bone marrow examination to rule out other hematological disorders. Management may include observation, treatment of underlying conditions, or interventions such as platelet transfusions or medications to stimulate platelet production. Understanding the nuances of this condition is crucial for accurate coding and appropriate patient management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from secondary causes of thrombocytopenia
  • Need for comprehensive clinical documentation
  • Potential overlap with other bleeding disorders
  • Variability in presentation and management

Audit Risk Factors

  • Inadequate documentation of platelet counts
  • Failure to specify the primary nature of thrombocytopenia
  • Misclassification with secondary thrombocytopenia codes
  • Lack of supporting lab results

Specialty Focus

Medical Specialties

Hematology

Documentation Requirements

Detailed clinical history, laboratory results, and treatment plans must be documented.

Common Clinical Scenarios

Patients presenting with unexplained bruising or bleeding, requiring evaluation of platelet levels.

Billing Considerations

Consideration of family history and genetic testing for inherited forms of thrombocytopenia.

Internal Medicine

Documentation Requirements

Comprehensive patient history and physical examination findings are essential.

Common Clinical Scenarios

Management of patients with chronic low platelet counts and associated symptoms.

Billing Considerations

Coordination with hematology for complex cases and potential referrals.

Coding Guidelines

Inclusion Criteria

Use D69.4 When
  • According to ICD
  • 10 guidelines, D69
  • 4 should be used when the thrombocytopenia is determined to be primary and not due to other underlying conditions

Exclusion Criteria

Do NOT use D69.4 When
  • Documentation must support the diagnosis and exclude secondary causes

Related ICD-10 Codes

Related CPT Codes

85027CPT Code

Complete blood count (CBC) with platelet count

Clinical Scenario

Used to monitor platelet levels in patients diagnosed with primary thrombocytopenia.

Documentation Requirements

Document the reason for the CBC and any relevant clinical findings.

Specialty Considerations

Hematologists may require more frequent monitoring based on the severity of thrombocytopenia.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of thrombocytopenia, enabling better tracking of primary versus secondary causes and improving patient management strategies.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of thrombocytopenia, enabling better tracking of primary versus secondary causes and improving patient management strategies.

Reimbursement & Billing Impact

reimbursement and compliance.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the common causes of primary thrombocytopenia?

Primary thrombocytopenia can be caused by inherited conditions affecting platelet production or function, as well as acquired conditions that disrupt normal hematopoiesis. It is essential to rule out secondary causes before confirming a diagnosis.