What is ICD-10 code D68.52?

D68.52 is the ICD-10-CM diagnosis code for Prothrombin gene mutation. A genetic mutation in the prothrombin gene that increases the tendency for blood clots to form abnormally. D68.52 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. D68.52 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. D68.52 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. D68.52 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for D68.52?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. D68.52 was a payment HCC under V24 (Coagulation Defects and Other Specified Hematological Disorders) but the V28 recalibration removed it from the risk adjustment model. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting D68.52?

This is an inherited condition; document genetic testing results and family history in the medical record Often found in patients with recurrent venous thromboembolism; code the thrombotic event separately Because D68.52 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

D68.52: Prothrombin gene mutation — ICD-10

ICD-10-CM Code View

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Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupD68.52Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89) / Coagulation defects, purpura and other hemorrhagic conditions (D65-D69)

D68.52

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Prothrombin gene mutation

A genetic mutation in the prothrombin gene that increases the tendency for blood clots to form abnormally.

Buddy Insight

Prothrombin gene mutation (G20210A) is the second most common inherited thrombophilia, present in approximately 2-3% of Caucasian populations.

CMS-HCC V28

Not risk-adjusted for this model/period.

RAF 0

CMS-HCC V24

Mapped

HCC 48

Coagulation Defects and Other...

RAF 0.209

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Mapped

HCC 48

Coagulation Defects and Other...

RAF 0.0

RXHCC

Not risk-adjusted for this model/period.

RAF 0

Code Trumping

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Code Book Path

Official

D68Other coagulation defects

D68.5Primary thrombophilia

D68.52Prothrombin gene mutation

Inclusion Terms

Official

Primary hypercoagulable states

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for D68.52 in this effective period.

Related Child Codes

Official

D68.51Activated protein C resistance

D68.59Other primary thrombophilia

Includes

Official

ICD-10-CM does not list Includes notes for D68.52 in this effective period.

Excludes 1

Official

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)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for D68.52 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for D68.52 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for D68.52 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Document genetic confirmation of the prothrombin G20210A mutation, zygosity status, prothrombin activity levels if measured, and personal/family history of venous thromboembolism.

Record whether the patient is on long-term anticoagulation and the indication, and any combined thrombophilic states.

MEAT Support

HCC Buddy guidance

Document genetic confirmation of the prothrombin G20210A mutation, zygosity status, prothrombin activity levels if measured, and personal/family history of venous thromboembolism.

Record whether the patient is on long-term anticoagulation and the indication, and any combined thrombophilic states.

Audit Caution

HCC Buddy guidance

Prothrombin gene mutation is a thrombophilic condition (causes clotting) not a bleeding disorder — do not confuse with prothrombin (factor II) deficiency which causes bleeding. The mutation results in elevated prothrombin levels, not reduced. Testing requires specific genetic analysis

routine PT/INR does not detect this mutation.

Common Mistakes

HCC Buddy guidance

D68.51 (Activated protein C resistance/Factor V Leiden) — different genetic thrombophilia that is more common

D68.59 (Other primary thrombophilia) — for inherited thrombophilias beyond Factor V Leiden and prothrombin mutation

D68.2 (Hereditary deficiency of other clotting factors) — factor deficiencies causing bleeding, not thrombosis.

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is D68.52 an HCC code?

Yes. D68.52 maps to Coagulation Defects and Other Specified Hematological Disorders under the V24 model but is not retained in V28.

HCC Category Mapping

V24HCC 48, Coagulation Defects and Other Specified Hematological Disorders

0.209

ESRDHCC 48, Coagulation Defects and Other Specified Hematological Disorders

0.000

RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

MEAT Criteria for D68.52

For D68.52to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed D68.52 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

D68.52 is the ICD-10-CM diagnosis code for prothrombin gene mutation. A genetic mutation in the prothrombin gene that increases the tendency for blood clots to form abnormally. D68.52 sits in the ICD-10-CM chapter for diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (d50-d89), within the section covering coagulation defects, purpura and other hemorrhagic conditions (d65-d69).

Under the older CMS-HCC V24 model, D68.52 maps to Coagulation Defects and Other Specified Hematological Disorders (HCC 48) with a community, non-dual, aged base RAF weight of 0.209. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.

This is an inherited condition; document genetic testing results and family history in the medical record. Because D68.52 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for D68.52 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This is an inherited condition; document genetic testing results and family history in the medical record
•Often found in patients with recurrent venous thromboembolism; code the thrombotic event separately

Clinical Significance

Prothrombin gene mutation (G20210A) is the second most common inherited thrombophilia, present in approximately 2-3% of Caucasian populations. Heterozygous carriers have a 2-3 fold increased risk of venous thromboembolism due to elevated prothrombin levels. The risk is amplified when combined with other thrombophilic conditions or environmental risk factors such as oral contraceptive use.

Documentation Requirements

✓Document genetic confirmation of the prothrombin G20210A mutation, zygosity status, prothrombin activity levels if measured, and personal/family history of venous thromboembolism.
✓Record whether the patient is on long-term anticoagulation and the indication, and any combined thrombophilic states.

Commonly Confused Codes

•D68.51 (Activated protein C resistance/Factor V Leiden): different genetic thrombophilia that is more common
•D68.59 (Other primary thrombophilia): for inherited thrombophilias beyond Factor V Leiden and prothrombin mutation
•D68.2 (Hereditary deficiency of other clotting factors): factor deficiencies causing bleeding, not thrombosis.