Updated on: July 26, 2025
Bleeding is a serious and potentially life-threatening complication of anticoagulant therapy. Whether triggered by warfarin, DOACs (e.g., apixaban, rivaroxaban), or heparin, anticoagulant-associated hemorrhage must be promptly recognized, documented, and coded with high accuracy. The ICD-10 code D68.32 specifically identifies hemorrhagic complications caused by therapeutic anticoagulation.
This guide helps clinicians correctly use D68.32, avoid miscoding bleeding disorders, and ensure accurate documentation for audit protection and timely patient care.
What Is ICD-10 Code D68.32?
D68.32 is used when:
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A patient on therapeutic anticoagulants develops clinically evident bleeding
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The bleeding is not caused by trauma, injury, or an unrelated condition
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The anticoagulant is the primary factor leading to the hemorrhage
D68.32 captures iatrogenic hemorrhagic disorders from blood thinners, not inherited or spontaneous bleeding conditions.
Examples of D68.32 in Practice
| Clinical Scenario | Use D68.32? | Notes |
|---|---|---|
| Hematuria in a patient on warfarin with supratherapeutic INR | ✅ Yes | D68.32 + R31.0 (gross hematuria) |
| GI bleeding on rivaroxaban | ✅ Yes | D68.32 + K92.2 (GI bleed) |
| Intracranial hemorrhage on apixaban | ✅ Yes | D68.32 + I61.9 (intracerebral hemorrhage) |
| Post-op bleeding unrelated to anticoagulation | ❌ No | Use surgical complication codes |
| Minor bruising without clinical intervention | ❌ No | Document but consider Z79.01 without D68.32 |
Primary Anticoagulants That May Cause D68.32 Events
| Medication Class | Examples |
|---|---|
| Vitamin K Antagonists | Warfarin (Coumadin) |
| Direct Oral Anticoagulants (DOACs) | Apixaban, Rivaroxaban, Edoxaban |
| Direct Thrombin Inhibitors | Dabigatran |
| Heparins | Unfractionated Heparin, LMWH |
| Antiplatelets (rare) | Dual therapy with anticoagulants |
Documentation Tips for D68.32
When using D68.32, your note should include:
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Medication name and dose (e.g., “Patient on warfarin 5 mg daily”)
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INR value, if relevant
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Type and location of bleeding (GI, intracranial, mucosal, etc.)
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Onset and severity (mild, severe, requiring hospitalization)
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Treatment administered (vitamin K, PCC, reversal agents)
Sample EHR Note:
“Patient on rivaroxaban for PE presents with melena and drop in Hb from 13.2 to 9.8. Endoscopy confirms upper GI bleed. Anticoagulant held. Diagnosis: Hemorrhagic disorder due to anticoagulants (D68.32) + Gastrointestinal hemorrhage (K92.2) + Z79.01 (long-term anticoagulant use).”
SOAP Note Example – D68.32
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S: “Black tarry stools x2 days, no abdominal pain.”
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O: Hb = 10.0 (baseline 13.2), INR 2.9, on warfarin
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A: Upper GI bleeding due to anticoagulant therapy (D68.32 + K92.1)
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P: Hold warfarin; IV fluids; GI consult for urgent endoscopy; initiate reversal protocol
Related Codes to Use With D68.32
| Condition | ICD-10 Code |
|---|---|
| Long-term anticoagulant use | Z79.01 |
| GI bleeding | K92.2 |
| Intracerebral hemorrhage | I61.9 |
| Hematuria | R31.0 |
| Anemia due to acute blood loss | D62 |
| INR elevation | R79.1 (optional) |
When NOT to Use D68.32
| Scenario | Better Code(s) |
|---|---|
| Inherited bleeding disorder | D66–D68.2 range (e.g., hemophilia) |
| Bleeding due to trauma or accident | Use injury codes (S00–S99 series) |
| Postoperative bleeding unrelated to meds | T81.0 – Hemorrhage complicating surgery |
| Minor bruising without clinical significance | Document, but D68.32 may not apply |
Management Strategies for Anticoagulant-Related Bleeding
Immediate Actions:
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Discontinue anticoagulant
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Assess severity and bleeding site
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Reverse anticoagulation if necessary (e.g., vitamin K, idarucizumab, andexanet alfa)
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Supportive care: IV fluids, blood transfusion, endoscopic or surgical control
Long-Term Considerations:
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Consider risk/benefit of restarting anticoagulation
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Modify dose or switch agents
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Increase INR monitoring frequency
Patient Education Tips
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Inform about warning signs of bleeding:
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Unexplained bruises, blood in urine/stool, prolonged bleeding
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Avoid NSAIDs and alcohol
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Reinforce consistent diet (esp. with warfarin)
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Ensure medication adherence and follow-up INR checks
FAQs
Is D68.32 billable as a primary diagnosis?
Yes. If the hemorrhage is directly due to anticoagulation, D68.32 is billable and often listed as the primary diagnosis in hospital encounters.
Can D68.32 be used for DOAC-related bleeds?
Yes. Any therapeutic anticoagulant, including DOACs, can be linked to D68.32 if it causes bleeding.
Should I still use Z79.01?
Yes. Always include Z79.01 to document long-term anticoagulant use, even in cases of acute bleed.
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Conclusion
ICD-10 Code D68.32 is essential for identifying and billing bleeding events due to anticoagulant use, a high-risk yet common clinical scenario. By using this code appropriately and pairing it with symptom and treatment codes, clinicians can ensure compliance, reduce liability, and optimize patient safety. With DocScrib, this process is automated, accurate, and stress-free.