ICD-10 D68.5
Non-Billable HeaderPrimary thrombophilia
About ICD-10-CM D68.5
ICD-10-CM code D68.5 represents Primary thrombophilia. This is a non-billable header code in the Blood and Blood-forming Organs chapter (block D68). The 2026 edition of ICD-10-CM D68.5 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under D68.5. Per CMS ICD-10-CM Tabular 2026.
- Primary hypercoagulable states
Type 1 Excludes
Pure excludes, these codes can never be coded together with D68.5. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- antiphospholipid syndrome (D68.61)
- lupus anticoagulant (D68.62)
- secondary activated protein C resistance (D68.69)
- secondary antiphospholipid antibody syndrome (D68.69)
- secondary lupus anticoagulant with hypercoagulable state (D68.69)
- secondary systemic lupus erythematosus [SLE] inhibitor with hypercoagulable state (D68.69)
- systemic lupus erythematosus [SLE] inhibitor finding without diagnosis (R76.0)
- systemic lupus erythematosus [SLE] inhibitor with hemorrhagic disorder (D68.312)
- thrombotic thrombocytopenic purpura (M31.19)
Medicare LCD Coverage for D68.5
Local Coverage Determinations (LCDs) from CMS MACs that list D68.5 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing D68.5.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but D68.5 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with D68.5
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.
Codes Adjacent To D68.5
Other codes in section D65-D69 (Coagulation defects, purpura and other hemorrhagic conditions).
ICD-10 D68.5, Billing FAQ
Is ICD-10 code D68.5 billable? +
No, D68.5 is a non-billable header code. Use a more specific child code from block D68 when submitting claims.
What other names or terms map to D68.5? +
ICD-10 D68.5 includes: Primary hypercoagulable states.
What codes are Type 1 Excludes for D68.5? +
Type 1 Excludes (never code together with D68.5): antiphospholipid syndrome (D68.61); lupus anticoagulant (D68.62); secondary activated protein C resistance (D68.69)
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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