Oncology & Hematology Coding Alert

Coagulation factor deficiency coding requires a look at the index.

ICD-10-CM code D68.4 has the same definition as ICD-9-CM code 286.7. That's not the end of the coding story, though. Here's how D68.32 fits into the picture, too.

ICD-9-CM code:

• 286.7, Acquired coagulation factor deficiency

ICD-10-CM codes:

• D68.32, Hemorrhagic disorder due to extrinsic circulating anticoagulants
• D68.4, Acquired coagulation factor deficiency

ICD-9-CM coding rules: Code 286.7 applies to deficiency of coagulation factor caused by liver disease or vitamin K deficiency. You should not use the code for vitamin K deficiency of a newborn, which is coded to 776.0 (Hemorrhagic disease of newborn). The code's also appropriate for acquired hypoprothrombinemia (prothrombin deficiency). ICD-9-CM instructs you to use an additional E-code to identify the cause if the deficiency is drug-induced.

ICD-10-CM changes: Code 286.7 maps to two ICD-10-CM codes: D68.32 and D68.4.

Code D68.32 applies to:

• Drug-induced hemorrhagic disorder
• Hemorrhagic disorder due to increase in anti-IIa
• Hemorrhagic disorder due to increase in anti-Xa
• Hyperheparinemia

ICD-10-CM instructs you to use an additional code for adverse effect, if applicable, to identify the drug that caused the disorder (T45.515, T45.525).

Code D68.4, which has the same definition as 286.7, applies to:

• Deficiency of coagulation factor due to liver disease
• Deficiency of coagulation factor due to vitamin K deficiency

This code also excludes vitamin K deficiency of newborn, which is coded to P53 (Hemorrhagic disease of newborn).

Documentation: When you review the "includes" lists for these codes, one phrase stands out: "due to." Be sure the physician understands the importance of documenting the cause of the disorder so you can choose the most specific code.

Coder tips: When you start using ICD-10-CM, apply the same rule you use for ICD-9-CM: look up the diagnosis in the index and then verify your code choice in the tabular list. The ICD-10-CM index reveals many additional terms coded to D68.32 and D68.4 that you won't find in the tabular list.

Remember: When ICD-10-CM goes into effect, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.