2027 ICD-10-CM Diagnosis Code D68.1Hereditary factor XI deficiency
ICD-10-CM Codes›D50–D89›D65-D69›D68
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 112
- Chronic Condition
D68.1 is a billable ICD-10-CM diagnosis code for hereditary factor XI deficiency. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 813. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 51 closely related codes. Coders also document this condition as factor XI deficiency. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Coagulation and hemorrhagic disorders.
For Medicare Advantage risk adjustment, D68.1 maps to CMS-HCC Category 112 (Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions) under the V28 model, adding a risk factor of about 0.450 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
D68.1 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Factor XI deficiency
- Factor XI deficiency, type I
- Factor XI deficiency, type II
- Factor XI deficiency, type III
- Hereditary factor XI deficiency disease
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to D68.1: its own notes plus those printed at D68 and Chapter 3. A note printed at a category, block or chapter applies to every code under it.
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Hemophilia C
- Plasma thromboplastin antecedent [PTA] deficiency
- Rosenthal's disease
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- autoimmune disease (systemic) NOS (M35.9)
- certain conditions originating in the perinatal period (P00-P96)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- human immunodeficiency virus [HIV] disease (B20)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name D68.1, its category, or a range that includes it.
Excludes1 1
These codes carry an Excludes1 note naming D68.1: they are not reported together with it, unless the two conditions are unrelated.
Excludes2 1
These codes carry an Excludes2 note naming D68.1: its condition is not part of those codes, and both may be reported when the patient has both.
- Block R70-R79 Abnormal findings on examination of blood, without diagnosis
Code First 1
These codes say to code first a condition named in the note, and D68.1 is one of the conditions named.
- M36.2 Hemophilic arthropathyhemophilia C (D68.1)
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
C D68.1
factor See Also: Deficiency, coagulation;
antecedent (PTA) D68.1
Disease, diseased See Also: Syndrome;
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Hereditary Factor XI Deficiency
a rare inherited bleeding disorder caused by deficiency of coagulation factor xi. it may be asymptomatic or manifest with bleeding.
Patient EducationClinical
Bleeding Disorders
Normally, if you get hurt, your body forms a blood clot to stop the bleeding. For blood to clot, your body needs cells called platelets and proteins known as clotting factors. If you have a bleeding disorder, you either do not have enough platelets or clotting factors or they don't work the way they should.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert D68.1 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About D68.1Overview
What is the ICD-10 code for hereditary factor XI deficiency?
The ICD-10-CM code for hereditary factor XI deficiency is D68.1 (sometimes written as D681). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is D68.1 (Other coagulation defects) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report hereditary factor XI deficiency on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does D68.1 group to?
When hereditary factor XI deficiency is the principal diagnosis on an inpatient stay, it groups to MS-DRG 813 (coagulation Disorders), which carries a relative weight of 1.5279. Higher weights mean higher Medicare reimbursement.
Is D68.1 a CC or MCC?
CMS lists D68.1 as a CC (complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 51 closely related codes in its exclusion list.
Can D68.1 be reported with R79.1?
Not as a rule. The Excludes1 note at D68, which applies to D68.1, lists "abnormal coagulation profile NOS (R79.1)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What HCC is D68.1?
D68.1 (hereditary factor XI deficiency) maps to CMS-HCC Category 112 (Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrhagic Conditions), commonly written as HCC 112, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 48 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does D68.1 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, D68.1 adds a risk adjustment factor of about 0.450 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.450 to 0.708 depending on the payment segment). A more severe related category (HCC 111) supersedes it when both are reported. See the full factor table on the HCC 112 category page.
