2026 ICD-10-CM Diagnosis Code D68.52Prothrombin gene mutation

ICD-10-CM Codes›D50–D89›D65-D69›D68

ICD-10-CM D68.52
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

D68.52 is a billable ICD-10-CM diagnosis code for prothrombin gene mutation. 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. Coders also document this condition as heterozygous prothrombin G20210A mutation. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Coagulation and hemorrhagic disorders.

D68.52 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

ICD-10-CM Code
D68.52
Billable Status
Yes — Valid for Submission
Code Describes
Prothrombin gene mutation
Short Description
Prothrombin gene mutation
Same as the full description in the CMS dataset.
Parent Code
D68.5
Primary thrombophilia

Code Classification

ChapterD50–D89Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
SectionD65-D69Coagulation defects, purpura and other hemorrhagic conditions
CategoryD68Other coagulation defects
This CodeD68.52Prothrombin gene mutation

Medicare Risk Adjustment (HCC)Billing

D68.52 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.

CMS-HCC V28 (Medicare Advantage Payment Model)
Not mapped
Dropped in V28 see all codes that no longer risk-adjust
Prior Model (CMS-HCC V24)
HCC 48
V24 retired last contributed to a Medicare Advantage risk score in payment year 2025
Other CMS Models
PACE (CMS-HCC V22): HCC 48 · ESRD (V21): HCC 48 · ESRD (V24): HCC 48
ESRD V21 weights: 0.059 dialysis, 0.173–0.234 functioning graft · ESRD V24 weights: 0.063 dialysis, 0.192–0.358 functioning graft
Part D (RxHCC)
Not mapped
D68.52 does not risk-adjust in the RxHCC prescription drug model

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.

  • Heterozygous prothrombin G20210A mutation
  • Homozygous prothrombin G20210A mutation
  • Prothrombin G20210A mutation

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR BLD006
Coagulation and hemorrhagic disorders
Default principal diagnosis: inpatient Yes · outpatient Yes

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 D68.52 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
289.81 Prim hypercoagulable st
Approximate The match is approximate rather than exact.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About D68.52Overview

What is the ICD-10 code for prothrombin gene mutation?

The ICD-10-CM code for prothrombin gene mutation is D68.52 (sometimes written as D6852). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

Is D68.52 (Primary thrombophilia) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report prothrombin gene mutation on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does D68.52 group to?

When prothrombin gene mutation 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 D68.52 a CC or MCC?

CMS lists D68.52 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 D68.52?

Under the General Equivalence Mappings, prothrombin gene mutation converts to ICD-9-CM 289.81 (prim hypercoagulable st). The mapping is approximate, so confirm the match fits the documentation.

Does D68.52 risk-adjust for Medicare Advantage payment?

Not for Medicare Advantage. D68.52 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).