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ICD-10 Guide
ICD-10 CodesD69.42

D69.42

Billable

Congenital and hereditary thrombocytopenia purpura

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

Code Description

ICD-10 D69.42 is a billable code used to indicate a diagnosis of congenital and hereditary thrombocytopenia purpura.

Key Diagnostic Point:

Congenital and hereditary thrombocytopenia purpura refers to a group of bleeding disorders characterized by a low platelet count (thrombocytopenia) that is present from birth or inherited. This condition can lead to easy bruising, prolonged bleeding from cuts, and spontaneous bleeding episodes. The underlying causes often involve genetic mutations affecting platelet production or function, leading to a reduced number of platelets in circulation. Patients may present with petechiae, purpura, or more severe bleeding complications. Diagnosis typically involves a thorough clinical evaluation, family history assessment, and laboratory tests to measure platelet counts and assess bone marrow function. Management may include platelet transfusions, immunosuppressive therapy, or splenectomy in severe cases. Understanding the genetic basis of the disorder is crucial for family planning and management of affected individuals. The condition can vary in severity, and its impact on quality of life can be significant, necessitating a multidisciplinary approach to care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity among patients
  • Need for genetic testing and family history documentation
  • Differentiation from acquired thrombocytopenia conditions
  • Potential for co-existing bleeding disorders

Audit Risk Factors

  • Inadequate documentation of family history
  • Failure to document genetic testing results
  • Misclassification of congenital vs. acquired thrombocytopenia
  • Lack of detailed clinical notes on bleeding episodes

Specialty Focus

Medical Specialties

Hematology

Documentation Requirements

Comprehensive patient history, including family history of bleeding disorders, detailed laboratory results, and treatment plans.

Common Clinical Scenarios

Diagnosis and management of patients with unexplained thrombocytopenia, evaluation of bleeding episodes, and genetic counseling.

Billing Considerations

Ensure accurate documentation of platelet counts and any interventions performed, as well as follow-up care.

Pediatrics

Documentation Requirements

Detailed growth and development assessments, family history, and any associated congenital anomalies.

Common Clinical Scenarios

Management of infants and children presenting with bruising or bleeding, and monitoring for complications.

Billing Considerations

Consider developmental milestones and the impact of the condition on the child's quality of life.

Coding Guidelines

Inclusion Criteria

Use D69.42 When
  • According to ICD
  • 10 guidelines, D69
  • 42 should be used when the thrombocytopenia is congenital or hereditary in nature
  • It is important to document the specific type of thrombocytopenia and any associated conditions

Exclusion Criteria

Do NOT use D69.42 When
  • Exclusion criteria include acquired causes of thrombocytopenia, which should be coded separately

Related ICD-10 Codes

Related CPT Codes

85027CPT Code

Complete blood count (CBC) with platelet count

Clinical Scenario

Used to evaluate patients presenting with symptoms of bleeding or bruising.

Documentation Requirements

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

Specialty Considerations

Hematologists may require additional tests to assess platelet function.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of congenital and hereditary conditions, improving the accuracy of diagnoses and treatment tracking. D69.42 provides a clear distinction from acquired forms of thrombocytopenia, enhancing clinical understanding and management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital and hereditary conditions, improving the accuracy of diagnoses and treatment tracking. D69.42 provides a clear distinction from acquired forms of thrombocytopenia, enhancing clinical understanding and management.

Reimbursement & Billing Impact

reimbursement and to ensure appropriate care management.

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 is the primary cause of congenital thrombocytopenia purpura?

Congenital thrombocytopenia purpura is primarily caused by genetic mutations that affect platelet production or function, leading to a reduced platelet count from birth.