2026 ICD-10-CM Diagnosis Code D68.61Antiphospholipid syndrome
ICD-10-CM Codes›D50–D89›D65-D69›D68
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Chronic Condition
D68.61 is a billable ICD-10-CM diagnosis code for antiphospholipid syndrome. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 814 through 816. 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 40 closely related codes. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Coagulation and hemorrhagic disorders.
D68.61 no longer risk-adjusts for Medicare Advantage: it mapped to HCC 48 under the retired CMS-HCC V24 model through payment year 2025 but maps to no category in the live V28 model. It still risk-adjusts in the PACE (CMS-HCC V22) category 48, ESRD (V21) category 48, and ESRD (V24) category 48 for payment year 2026.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
D68.61 no longer risk-adjusts for Medicare Advantage: it maps to no payment category in the live CMS-HCC V28 model, although it still risk-adjusts in the other CMS models shown below.
Source: CMS Payment Year 2026 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.
- Antiphospholipid syndrome
- Antiphospholipid syndrome in pregnancy
- Catastrophic antiphospholipid syndrome
- Chorea due to antiphospholipid syndrome
- Chorea due to immunological disorder
- Myelitis due to anti-phospholipid syndrome
- Neonatal antiphospholipid syndrome
- Primary antiphospholipid syndrome
- Primary antiphospholipid syndrome with multisystem involvement
- Secondary antiphospholipid syndrome
- Secondary antiphospholipid syndrome with multisystem involvement
- Thrombophilia associated with pregnancy
- White matter disease due to anti-phospholipid syndrome
Tabular List NotesGuidance
Coding notes and annotation back-references applicable to this code.
Inclusion Terms
- Anticardiolipin syndrome
- Antiphospholipid antibody syndrome
Type 1 Excludes
- anti-phospholipid antibody, finding without diagnosis R76.0
Type 2 Excludes
These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
A type 1 excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
A type 2 excludes note represents "Not included here". An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
hypercoagulable state D68.61
antiphosphatidylglycerol R76.0
hypercoagulable state D68.61
antiphosphatidylinositol R76.0
hypercoagulable state D68.61
hypercoagulable state D68.61
hypercoagulable state D68.61
Anticardiolipin syndrome D68.61
Syndrome See Also: Disease;
anticardiolipin (-antibody) D68.61
antiphospholipid (-antibody) D68.61
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Antiphospholipid Syndrome
the presence of antibodies directed against phospholipids (antibodies, antiphospholipid). the condition is associated with a variety of diseases, notably systemic lupus erythematosus and other connective tissue diseases, thrombopenia, and arterial or venous thromboses. in pregnancy it can cause abortion. of the phospholipids, the cardiolipins show markedly elevated levels of anticardiolipin antibodies (antibodies, anticardiolipin). present also are high levels of lupus anticoagulant (lupus coagulation inhibitor).
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 D68.61 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About D68.61Overview
What is the ICD-10 code for antiphospholipid syndrome?
The ICD-10-CM code for antiphospholipid syndrome is D68.61 (sometimes written as D6861). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
Is D68.61 (Other thrombophilia) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report antiphospholipid syndrome on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does D68.61 group to?
When antiphospholipid syndrome is the principal diagnosis on an inpatient stay, it groups to MS-DRG 814, 815, 816, with relative weights from 0.6320 to 2.1267 depending on complications. Higher weights mean higher Medicare reimbursement.
Is D68.61 a CC or MCC?
CMS lists D68.61 as a CC (complication or comorbidity) for FY 2026. 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 40 closely related codes in its exclusion list.
What is the ICD-9 equivalent of D68.61?
Under the General Equivalence Mappings, antiphospholipid syndrome converts to ICD-9-CM 289.81 (prim hypercoagulable st). The mapping is approximate, so confirm the match fits the documentation.
Does D68.61 risk-adjust for Medicare Advantage payment?
Not for Medicare Advantage. D68.61 mapped to HCC 48 in the retired CMS-HCC V24 model, which last determined payment in 2025, but it maps to no category in the live V28 model; see all codes that no longer risk-adjust. It still risk-adjusts in the PACE (CMS-HCC V22) category 48 (Coagulation Defects and Other Specified Hematological Disorders), ESRD (V21) category 48 (Coagulation Defects and Other Specified Hematological Disorders), and ESRD (V24) category 48 (Coagulation Defects and Other Specified Hematological Disorders).
