ICD-10 D68.312
Billable / Specific HCC v28: 48 CCAntiphospholipid antibody with hemorrhagic disorder
About ICD-10-CM D68.312
ICD-10-CM code D68.312 represents Antiphospholipid antibody with hemorrhagic disorder. This is a billable/specific code in the Blood and Blood-forming Organs chapter (block D68). The 2026 edition of ICD-10-CM D68.312 became effective on October 1, 2025.
Coding Tips for D68.312
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
D68.312 is a CMS-HCC v28 risk-adjustment code (category 48). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
D68.312 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under D68.312. Per CMS ICD-10-CM Tabular 2026.
- Lupus anticoagulant (LAC) with hemorrhagic disorder
- Systemic lupus erythematosus [SLE] inhibitor with hemorrhagic disorder
Type 1 Excludes
Pure excludes, these codes can never be coded together with D68.312. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- antiphospholipid antibody, finding without diagnosis (R76.0)
- lupus anticoagulant (LAC) finding without diagnosis (R76.0)
- systemic lupus erythematosus [SLE] inhibitor finding without diagnosis (R76.0)
Type 2 Excludes
Not included here, the excluded code is not part of D68.312, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- antiphospholipid antibody syndrome (D68.61)
- antiphospholipid antibody with hypercoagulable state (D68.61)
- lupus anticoagulant (LAC) with hypercoagulable state (D68.62)
- systemic lupus erythematosus [SLE] inhibitor with hypercoagulable state (D68.62)
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, CC
codes Antiphospholipid antibody with hemorrhagic disorder. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for D68.312
Local Coverage Determinations (LCDs) from CMS MACs that list D68.312 as a covered diagnosis.
Showing top 7. Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing D68.312.
1 Medicare
CPT Codes Commonly Billed with D68.312
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert D68.312 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| D68.312 | 28653 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To D68.312
Other codes in section D65-D69 (Coagulation defects, purpura and other hemorrhagic conditions).
ICD-10 D68.312, Billing FAQ
Is ICD-10 code D68.312 billable? +
Yes, D68.312 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to D68.312? +
ICD-10 D68.312 includes: Lupus anticoagulant (LAC) with hemorrhagic disorder; Systemic lupus erythematosus [SLE] inhibitor with hemorrhagic disorder.
What codes are Type 1 Excludes for D68.312? +
Type 1 Excludes (never code together with D68.312): antiphospholipid antibody, finding without diagnosis (R76.0); lupus anticoagulant (LAC) finding without diagnosis (R76.0); systemic lupus erythematosus [SLE] inhibitor finding without diagnosis (R76.0)
What codes are Type 2 Excludes for D68.312? +
Type 2 Excludes (may be coded together when both conditions exist): antiphospholipid antibody syndrome (D68.61); antiphospholipid antibody with hypercoagulable state (D68.61); lupus anticoagulant (LAC) with hypercoagulable state (D68.62)
Does D68.312 affect Medicare Advantage HCC risk adjustment? +
Yes. D68.312 maps to CMS-HCC v28 category 48. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is D68.312 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What ICD-9 codes does D68.312 map to? +
Per CMS GEMs, D68.312 maps to ICD-9 codes: 28653. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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