D68.5 vs R76.0
D68.5 and R76.0 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter.
The official note, declared on D68.5
systemic lupus erythematosus [SLE] inhibitor finding without diagnosis (R76.0)
D68.5
Primary thrombophilia
Not billable
- Chapter 3
- Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
- Section
- D65-D69
Use when the record says
- Primary hypercoagulable states
R76.0
Raised antibody titer
Billable
- Chapter 18
- Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
- Section
- R70-R79
Indexed under
- Antibody › anticardiolipin
- Antibody › antiphosphatidylglycerol
- Antibody › antiphosphatidylinositol
- Antibody › antiphosphatidylserine
- Antibody › antiphospholipid
These two codes sit in different chapters of the Tabular List, which is usually the clearest signal that they describe different underlying processes rather than different degrees of the same one.
Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027