Coding and coverage · ICD-10-CM

D68 › D68.5

D68.51 Activated protein C resistance

BillableNo payment HCCChapter 3
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Instructional notes

Chapter 3

Excludes2Not included here: the patient may have both; report both when both are present.
  • autoimmune disease (systemic) NOS (M35.9)
  • certain conditions originating in the perinatal period (P00-P96)
  • complications of pregnancy, childbirth and the puerperium (O00-O9A)
  • congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
  • endocrine, nutritional and metabolic diseases (E00-E88)
  • human immunodeficiency virus [HIV] disease (B20)
  • injury, poisoning and certain other consequences of external causes (S00-T88)
  • neoplasms (C00-D49)
  • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

D68

Excludes1Not coded here: never report with this code, except when the two conditions are unrelated.
  • abnormal coagulation profile NOS (R79.1)
Excludes2Not included here: the patient may have both; report both when both are present.
  • 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)

D68.5

Excludes1Not coded here: never report with this code, except when the two conditions are unrelated.
  • 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)
Inclusion terms
  • Primary hypercoagulable states

This code

Inclusion terms
  • Factor V Leiden mutation

Chapter 3: Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism · D65-D69 Coagulation defects, purpura and other hemorrhagic conditions (D65-D69)

Source: ICD-10-CM FY 2027 code descriptions and tabular list (CMS and CDC National Center for Health Statistics), effective 2026-10-01 through 2027-09-30 · CMS ICD-10 files. HCC mapping: CMS-HCC V28, payment year 2027. As of 2026-11-04.

Coverage and payment depend on the claim details; confirm with the Medicare Administrative Contractor.