Skip to main content

D68.52 ICD-10-CM Code: Prothrombin gene mutation

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
10 Excludes1 · 2 Excludes2
Risk adjustment
CMS-HCC V22 category 48

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 814 — RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC (MDC 16)
  • MS-DRG 815 — RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC (MDC 16)
  • MS-DRG 816 — RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC (MDC 16)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for D68.52 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on D68.52 itself; “inherited from” names the category or block whose note applies here.

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Source: inherited from D68

Coder workflow for D68.52

MedCoder structured workflow — derived from this code’s own official record

Before you code D68.52

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with D68.52. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in D68.52’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewD68.61, D68.62, D68.69, R76.0, D68.312, M31.19

Consider D68.52. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

Official instructions as workflow

  • Excludes1 — check before selecting D68.52(10 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with D68.52: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareD68.61, D68.62, D68.69, R76.0, D68.312, M31.19

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of D68.52(2 notes)

    Coding workflow: The conditions named in this note are not included in D68.52. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareO08.1, O45.0, O46.0, O67.0, O72.3

    See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition D68.52 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewD68.61, D68.62, D68.69, R76.0, D68.312, M31.19

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Prothrombin gene mutation is a billable ICD-10-CM diagnosis code (D68.52).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (3)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Official Coding Guidelines

No excerpt in the ICD-10-CM Official Guidelines names this code specifically. Its chapter carries only this chapter-wide note:

Chapter 3: Disease of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)

Reserved for future guideline expansion

Verify Before Coding

  • CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name D68.52 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Excludes1 note: R79.1 — Abnormal coagulation profile (via D68.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 10 Excludes2 notes: R70 — Elevated erythrocyte sedimentation rate and abnormality of plasma viscosity (via D68.-), R70-R79 — Abnormal findings on examination of blood, without diagnosis (R70-R79) (via D68.-), R71 — Abnormality of red blood cells (via D68.-), R73 — Elevated blood glucose level (via D68.-), R74 — Abnormal serum enzyme levels (via D68.-), R75 — Inconclusive laboratory evidence of human immunodeficiency virus [HIV] (via D68.-), R76 — Other abnormal immunological findings in serum (via D68.-), R77 — Other abnormalities of plasma proteins (via D68.-), R78 — Findings of drugs and other substances, not normally found in blood (via D68.-), R79 — Other abnormal findings of blood chemistry (via D68.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 21 Code First instructions: T36 — Poisoning by, adverse effect of and underdosing of systemic antibiotics (via D68.-), T36-T39 — Antibiotics & Anti-infectives (T36-T39) (via D68.-), T36-T50 — Poisoning by, adverse effects of and underdosing of drugs, medicaments and biological substances (T36-T50) (via D68.-), T37 — Poisoning by, adverse effect of and underdosing of other systemic anti-infectives and antiparasitics (via D68.-), T38 — Poisoning by, adverse effect of and underdosing of hormones and their synthetic substitutes and antagonists, not elsewhere classified (via D68.-), T39 — Poisoning by, adverse effect of and underdosing of nonopioid analgesics, antipyretics and antirheumatics (via D68.-), T40 — Poisoning by, adverse effect of and underdosing of narcotics and psychodysleptics [hallucinogens] (via D68.-), T40-T41 — Analgesics & Antipyretics (T40-T41) (via D68.-), T41 — Poisoning by, adverse effect of and underdosing of anesthetics and therapeutic gases (via D68.-), T42 — Poisoning by, adverse effect of and underdosing of antiepileptic, sedative- hypnotic and antiparkinsonism drugs (via D68.-), T42-T43 — Anticonvulsants & Psychotropics (T42-T43) (via D68.-), T43 — Poisoning by, adverse effect of and underdosing of psychotropic drugs, not elsewhere classified (via D68.-), T44 — Poisoning by, adverse effect of and underdosing of drugs primarily affecting the autonomic nervous system (via D68.-), T44-T46 — Cardiovascular & Gastrointestinal (T44-T46) (via D68.-), T45 — Poisoning by, adverse effect of and underdosing of primarily systemic and hematological agents, not elsewhere classified (via D68.-), T46 — Poisoning by, adverse effect of and underdosing of agents primarily affecting the cardiovascular system (via D68.-), T47 — Poisoning by, adverse effect of and underdosing of agents primarily affecting the gastrointestinal system (via D68.-), T47-T50 — Hormones & Systemic Agents (T47-T50) (via D68.-), T48 — Poisoning by, adverse effect of and underdosing of agents primarily acting on smooth and skeletal muscles and the respiratory system (via D68.-), T49 — Poisoning by, adverse effect of and underdosing of topical agents primarily affecting skin and mucous membrane and by ophthalmological, otorhinorlaryngological and dental drugs (via D68.-), +1 more.

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 40 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 3 MS-DRGs: DRG 814 (MDC 16), DRG 815 (MDC 16), DRG 816 (MDC 16).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):BLD006 — Coagulation and hemorrhagic disorders (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

D47.4 — Osteomyelofibrosis, D68.312 — Antiphospholipid antibody with hemorrhagic disorder, D68.51 — Activated protein C resistance, D68.59 — Other primary thrombophilia, D68.61 — Antiphospholipid syndrome, D68.62 — Lupus anticoagulant syndrome, D68.69 — Other thrombophilia, D70.0 — Congenital agranulocytosis, D70.1 — Agranulocytosis secondary to cancer chemotherapy, D70.2 — Other drug-induced agranulocytosis, D70.3 — Neutropenia due to infection, D70.4 — Cyclic neutropenia, D70.8 — Other neutropenia, D70.9 — Neutropenia, unspecified, D71.1 — Leukocyte adhesion deficiency, D71.8 — Other functional disorders of polymorphonuclear neutrophils, D71.9 — Functional disorders of polymorphonuclear neutrophils, unspecified, D72.0 — Genetic anomalies of leukocytes, D72.810 — Lymphocytopenia, D72.818 — Other decreased white blood cell count, +19 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Coagulation and hemorrhagic disorders).

D68.04 — Acquired von Willebrand disease, D68.09 — Other von Willebrand disease, D68.1 — Hereditary factor XI deficiency, D68.2 — Hereditary deficiency of other clotting factors, D68.311 — Acquired hemophilia, D68.312 — Antiphospholipid antibody with hemorrhagic disorder, 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, D68.51 — Activated protein C resistance, D68.59 — Other primary thrombophilia, D68.61 — Antiphospholipid syndrome, D68.62 — Lupus anticoagulant syndrome, D68.69 — Other thrombophilia, D68.8 — Other specified coagulation defects, D68.9 — Coagulation defect, unspecified, D69.0 — Allergic purpura, D69.1 — Qualitative platelet defects, D69.2 — Other nonthrombocytopenic purpura, D69.3 — Immune thrombocytopenic purpura, +31 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Mutation”; these codes share that main term but sit in a different category of the Tabular List.

J84.83 — Surfactant mutations of the lung

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Partial Thromboplastin Time (PTT) Test, Prothrombin Time Test and INR (PT/INR)

Contextual Map

Every relationship of D68.52 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run D68.52 with these 17 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Excludes2 notes (10)

Referenced by Code First instructions (21)

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 16 — Diseases and Disorders of Blood, Blood Forming Organs and Immunologic Disorders[MDC crossing]: “Diseases and Disorders of Blood, Blood Forming Organs and Immunologic Disorders — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 1,614 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Hypercoagulable (state), prothrombin gene mutation[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Mutation (s), prothrombin gene[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Prothrombin gene mutation[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (31)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "D68.52 — Prothrombin gene mutation." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/d68.52-prothrombin-gene-mutation

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Prothrombin gene mutation

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to D68.52 in its code family, with their registry titles.

View all codes in the D68 family