ICD-10 D69.1
Billable / Specific HCC v28: 48Qualitative platelet defects
About ICD-10-CM D69.1
ICD-10-CM code D69.1 represents Qualitative platelet defects. This is a billable/specific code in the Blood and Blood-forming Organs chapter (block D69). The 2026 edition of ICD-10-CM D69.1 became effective on October 1, 2025.
Coding Tips for D69.1
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
D69.1 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.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under D69.1. Per CMS ICD-10-CM Tabular 2026.
- Bernard-Soulier [giant platelet] syndrome
- Glanzmann's disease
- Grey platelet syndrome
- Thromboasthenia (hemorrhagic) (hereditary)
- Thrombocytopathy
Type 1 Excludes
Pure excludes, these codes can never be coded together with D69.1. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- hemolytic-uremic syndrome (D59.3-)
Type 2 Excludes
Not included here, the excluded code is not part of D69.1, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- von Willebrand disease (D68.0-)
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.
Medicare LCD Coverage for D69.1
Local Coverage Determinations (LCDs) from CMS MACs that list D69.1 as a covered diagnosis.
Showing top 10 of 74 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing D69.1.
1 Cigna
4 Medicare
1 Aetna
CPT Codes Commonly Billed with D69.1
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- J7187 CMS LCD: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 CMS LCD
- J7201 CMS LCD: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 CMS LCD
- J7179 CMS LCD: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 CMS LCD
- J7194 CMS LCD: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 CMS LCD
- J7180 CMS LCD: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 CMS LCD
- J7175 CMS LCD: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 CMS LCD
- J7189 CMS LCD: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 CMS LCD
- J7209 CMS LCD: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 CMS LCD
- J7186 CMS LCD: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 CMS LCD
- J7182 CMS LCD: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3 CMS LCD
Convert D69.1 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 |
|---|---|---|
| D69.1 | 2871 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To D69.1
Other codes in section D65-D69 (Coagulation defects, purpura and other hemorrhagic conditions).
ICD-10 D69.1, Billing FAQ
Is ICD-10 code D69.1 billable? +
Yes, D69.1 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 D69.1? +
ICD-10 D69.1 includes: Bernard-Soulier [giant platelet] syndrome; Glanzmann's disease; Grey platelet syndrome, and 2 more clinical synonyms.
What codes are Type 1 Excludes for D69.1? +
Type 1 Excludes (never code together with D69.1): hemolytic-uremic syndrome (D59.3-)
What codes are Type 2 Excludes for D69.1? +
Type 2 Excludes (may be coded together when both conditions exist): von Willebrand disease (D68.0-)
Does D69.1 affect Medicare Advantage HCC risk adjustment? +
Yes. D69.1 maps to CMS-HCC v28 category 48. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with D69.1? +
Procedures frequently paired with D69.1 include: J7187, J7201, J7179, J7194, J7180.
What ICD-9 codes does D69.1 map to? +
Per CMS GEMs, D69.1 maps to ICD-9 codes: 2871. 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 July 16, 2026.
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