D68.52 Prothrombin gene mutation

Billable ICD-10-CM code, FY2026. Acts as a Complication or Comorbidity (CC) as a secondary diagnosis.

Applies from D68 Other coagulation defects

Excludes1 (never code together)

• abnormal coagulation profile NOS (R79.1)

Excludes2 (not included here)

• coagulation defects complicating abortion or ectopic or molar pregnancy (O00-O07, O08.1)
• coagulation defects complicating pregnancy, childbirth and the puerperium (O45.0, O46.0, O67.0, O72.3)

Applies from D68.5 Primary thrombophilia

Applicable to

• Primary hypercoagulable states

Excludes1 (never code together)

• antiphospholipid syndrome (D68.61)
• lupus anticoagulant (D68.62)
• secondary activated protein C resistance (D68.69)
• secondary antiphospholipid antibody syndrome (D68.69)
• secondary lupus anticoagulant with hypercoagulable state (D68.69)
• secondary systemic lupus erythematosus [SLE] inhibitor with hypercoagulable state (D68.69)
• systemic lupus erythematosus [SLE] inhibitor finding without diagnosis (R76.0)
• systemic lupus erythematosus [SLE] inhibitor with hemorrhagic disorder (D68.312)
• thrombotic thrombocytopenic purpura (M31.19)

Risk adjustment (HCC)

• CMS-HCC V22: HCC 48 — Coagulation Defects and Other Specified Hematological Disorders
• ESRD V24: HCC 48

MS-DRG index

Defines the logic of DRG(s) 814-816 in MDC 16.

Approximate ICD-9-CM (GEMs)

• 289.81 Primary hypercoagulable state (approximate)

Code annotations containing back-references to D68.52

Back-references to D68

• Type 1 Excludes: R79.1 Abnormal coagulation profile ("coagulation defects (D68.-)")

Diagnosis Index entries for D68.52

• Hypercoagulable (state) › prothrombin gene mutation
• Mutation (s) › prothrombin gene
• Prothrombin gene mutation

Nearby codes

• D68.318 Other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors
• D68.32 Hemorrhagic disorder due to extrinsic circulating anticoagulants
• D68.4 Acquired coagulation factor deficiency
• D68.5 Primary thrombophilia
• D68.51 Activated protein C resistance
• D68.52 Prothrombin gene mutation (this code)
• D68.59 Other primary thrombophilia
• D68.6 Other thrombophilia
• D68.61 Antiphospholipid syndrome
• D68.62 Lupus anticoagulant syndrome
• D68.69 Other thrombophilia