ICD-10 D68.51
Billable / Specific HCC v28: 48 CCActivated protein C resistance
About ICD-10-CM D68.51
ICD-10-CM code D68.51 represents Activated protein C resistance. This is a billable/specific code in the Blood and Blood-forming Organs chapter (block D68). The 2026 edition of ICD-10-CM D68.51 became effective on October 1, 2025.
Coding Tips for D68.51
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
D68.51 is a CMS-HCC v28 risk-adjustment code (category 48). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
D68.51 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under D68.51. Per CMS ICD-10-CM Tabular 2026.
- Factor V Leiden mutation
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, CC
codes Activated protein C resistance. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for D68.51
Local Coverage Determinations (LCDs) from CMS MACs that list D68.51 as a covered diagnosis.
Showing top 10 of 18 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing D68.51.
1 Cigna
2 Medicare
4 Aetna
CPT Codes Commonly Billed with D68.51
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 93970 Duplex venous extremity — DVT, venous thrombosis, edema, limb pain, personal hx DVT, thrombophilia Cardiology
- 71260 CT chest with contrast — pulmonary embolism, chest pain, dyspnea, wheezing, pulmonary HTN, lung cancer, nodule, thrombophilia Radiology
- 93990 CMS LCD: Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies CMS LCD
- 93985 CMS LCD: Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies CMS LCD
- 93986 CMS LCD: Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies CMS LCD
Convert D68.51 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| D68.51 | 28981 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To D68.51
Other codes in section D65-D69 (Coagulation defects, purpura and other hemorrhagic conditions).
ICD-10 D68.51, Billing FAQ
Is ICD-10 code D68.51 billable? +
Yes, D68.51 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to D68.51? +
ICD-10 D68.51 includes: Factor V Leiden mutation.
Does D68.51 affect Medicare Advantage HCC risk adjustment? +
Yes. D68.51 maps to CMS-HCC v28 category 48. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is D68.51 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with D68.51? +
Procedures frequently paired with D68.51 include: 93970, 71260, 93990, 93985, 93986.
What ICD-9 codes does D68.51 map to? +
Per CMS GEMs, D68.51 maps to ICD-9 codes: 28981. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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