PARTIAL THROMBOPLASTIN TIME (PTT)

Transcription

1 PARTIAL THROMBOPLASTIN TIME (PTT) NCD Source: Program Memorandum AB , Effective ; Medicare NCD Manual, July 2003 Release, October 2003 Release, January 2004 Release, October 2004 Release, October 2005 Release, October 2006 Release, January 2007 Release, October 2008 Release, April 2009 Release, October 2009 Release, October 2010 Release CMS (Medicare) has determined that Partial Thromboplastin Time (PTT) (CPT Code 85730) is only medically necessary and, therefore, reimbursable by Medicare when ordered for patients with any of the diagnostic conditions listed below in the ICD-9-CM Codes Covered by Medicare Program. If you are ordering this test for a diagnostic condition other than those listed below, please have your patient sign and date an Advanced Beneficiary Notice (ABN). All ICD-9-CM codes provided must be consistent with the documentation in the patient s medical records for the date of service. NOTE: Please be aware that it is not enough to link the procedure code to a correct, payable ICD-9-CM diagnosis code. The diagnosis must be present for the procedure to be paid. In addition, the procedure must be reasonable and necessary for that diagnosis. Documentation within the beneficiary's medical record must support the necessity for the test(s) provided for each date of service. For additional information, see the Limited Coverage Guidebook Information provided in this section. ICD-9-CM Codes Covered by Medicare Program: Typhoid and paratyphoid Salmonella gastroenteritis septicemia Localized salmonella infections Salmonella infection specified or unspecified Unspecified Septicemia 042 Human immunodeficiency virus (HIV) disease Yellow fever Arthropod borne hemorrhagic fever Viral hepatitis A with hepatic coma or without mention of hepatic coma Viral Hepatitis B,C, Delta, E, Viral with hepatic coma, without mention of hepatic coma; Hepatitis Delta with hepatitis B carrier state Unspecified viral hepatitis with hepatic coma Unspecified viral hepatitis C Unspecified viral hepatitis without mention of hepatic coma 075 Infectious mononucleosis Hemorrhagic fever arenaviral, nephrosonephritis Schistosomiasis haematobium Clonorchiasis Fascioliasis 124 Trichinosis 135 Sarcoidosis Malignant neoplasm of liver and intrahepatic bile ducts Malignant neoplasm of liver, specified as secondary Polycythemia vera Other lymphatic and hemapoietic tissues Neoplasm of unspecified nature, site unspecified Hemorrhage and infarction of thyroid Secondary diabetes mellitus with renal manifestations not stated as controlled or unspecified Secondary diabetes mellitus with opthalmalic manifestations, uncontrolled Diabetic with renal manifestations 1 of 7

2 269.0 Deficiency of Vitamin K Disorders of plasma protein metabolism * Hereditary hemochromatosis, hemochromatosis due to repeated blood cell transfusions, other hemochromatosis, other disorders of iron metabolism Disorders of mineral metabolism iron, copper, magnesium, and phosphorus Disorders of calcium metabolism Hungry bone syndrome Other disorders of mineral metabolism specified, unspecified Disorders of porphyrin metabolism Amyloidosis Acute posthemorrhagic anemia Congenital factor VIII disorder Hemophilia A Congenital factor IX disorder Hemophilia B Other congenital factor deficiencies von Willebrand's disease Hemorrhagic disorder due to circulating anticoagulants Defibrination syndrome Acquired coagulation factor deficiency Other and unspecified coagulation defects Purpura and other hemorrhagic conditions Primary thrombocytopenia * Posttransfusion purpura, other secondary thrombocytopenia Thrombocytopenia - secondary, unspecified / other specified hemorrhagic conditions, unspecified hemorrhagic conditions Polycythemia, secondary Primary hypercoagulable state 325 Phlebitis and thrombophlebitis of intracranial venous sinuses Hemophthalmos, except current injury Retinal vascular occlusion Hemorrhagic detachment of retinal pigment epithelium Retinal hemorrhage Choroidal hemorrhage Choroidal detachment Unspecified Visual Disturbances Conjunctive hemorrhage Hemorrhage of eyelid Orbital hemorrhage Hemorrhage in optic nerve sheaths Vitreous hemorrhage Hematoma of auricle or pinna , , Hypertensive renal disease with renal failure , , Hypertensive heart and renal disease with renal failure Acute myocardial infarction Hemopericardium Atrial fibrillation Cardiac dysrhythmias, unspecified Congestive heart failure, unspecified Mural thrombus Hemorrhage subarachnoid, intracerebral Other and unspecified cranial hemorrhage Occlusion and stenosis of precerebral arteries Occlusion of cerebral arteries 2 of 7

3 435.9 Focal neurologic deficit Arterial embolism and thrombosis, arthersclerosis Thrombotic microangiopathy Rupture of artery Hereditary Hemorrhagic telangiectasia Phlebitis and thrombophlebitis Phlebitis and thrombophlebitis of deep vessels of lower extremities Phlebitis and thrombophlebitis of lower extremities unspecified Phlebitis and thrombophlebitis of other sites Phlebitis and thrombophlebitis of unspecified site Other Venous emboli and thrombosis Venous embolism and thrombosis of deep vessels of lower extremity Chronic venous embolism and thrombosis of deep vessels of lower extremity Venous embolism and thrombosis of superficial vessels of lower extremity Chronic venous embolism and thrombosis of other specified vessels Acute venous embolism and thrombosis of other specified veins Venous embolism and thrombosis of unspecified site Esophegeal varices with / without bleeding Varices of other sites Other specified disorders of the circulatory system-phlebosclerosis, venofibrosis Gastroesophageal laceration hemorrhage syndrome Esophageal hemorrhage Gastric-Duodenal ulcer disease Eosinophilic gastritis with or without mention of hemorrhage Other specified disorders of stomach and duodenum Ulcerative colitis, vascular insufficiency of intestine Diverticulosis of small intestine with hemorrhage Diverticulosis of colon with hemorrhage Diverticulitis of colon with hemorrhage Hemoperitoneum (nontraumatic) Hemorrhage of rectum and anus 570 Acute and subacute necrosis of liver Chronic liver disease and cirrhosis Chronic hepatitis Liver disease cirrhosis without mention of alcohol, liver abscess and sequelae, other disorders Biliary tract disorders Acute pancreatitis Gastrointestinal Hemorrhage Malabsorption Nephrotic Syndrome Nephritis, with unspecified pathological lesion in kidney Acute Renal Failure Chronic kidney disease 586 Renal failure Other disorders of kidney and ureter, with hemorrhage Hemorrhage into bladder wall/ other disorders of bladder, with hemorrhage Hematuria Vascular disorders of penis Vascular disorders of male genital organs Other specified disorders of breast Hematoma of broad ligament Hematometra Other specified disorders of cervix, with hemorrhage 3 of 7

4 623.6 Vaginal hematoma Cyst, hemorrhage of vagina Hematoma of vulva Metrorrhagia Postcoital bleeding Premenopausal, postmenopausal bleeding Postmenopausal bleeding Hematocele female not elsewhere classified 632 Missed abortion Spontaneous abortion Legally induced abortion, complicated by delayed or excessive hemorrhage Illegally induced abortion, complicated by delayed or excessive hemorrhage Abortion unspecified, complicated by delayed or excessive hemorrhage Failed attempt abortion, complicated by delayed or excessive hemorrhage Delayed or excessive hemorrhage following abortion and ectopic and molar pregnancies Complications following abortion and ectopic and molar pregnancies, embolism Hemorrhage in early pregnancy Antepartum hemorrhage Hypertension complicating pregnancy, childbirth, and the puerperium Liver disorders in pregnancy Coagulation defects complicating pregnancy, childbirth or the puerperium Spotting complicating pregnancy Fetal maternal hemorrhage Infection of amniotic cavity Postpartum hemorrhage Phlebitis in pregnancy Obstetrical pulmonary embolus Other complications of surgical wounds, with hemorrhage Systemic Lupus erythematosus Arthropathy associated with hematologic disorders (note: may not be used without indicating associated condition first) Arthropathy associated with Henoch Schonlein (note: may not be used without indicating associated condition first) Hemarthrosis Pain in limb Swelling of the limb Pathologic fracture associated with fat embolism Other forms of placental separation with hemorrhage (affecting newborn code do not assign to mother s record) Fetal intrauterine growth retardation Subdural and cerebral hemorrhage Epicranial subaponeurotic hemorrhage Other specified birth trauma, with hemorrhage Fetal and newborn pulmonary hemorrhage Fetal and neonatal hemorrhage Fetal and neonatal intraventricular hemorrhage Fetal and neonatal hemorrhage- subarachnoid, umbilical (after birth), gastrointestinal, adrenal, cutaneous, other specified, unspecified Other perinatal jaundice Neonatal jaundice due to delayed conjugation from other causes Perinatal jaundice hepatocellular damage, other causes/ unspecified fetal and neonatal jaundice/ kernicterus not due to isoimmunization Hemorrhagic disease of the newborn 4 of 7

5 780.2 Syncope Jaundice, unspecified, not of newborn Spontaneous ecchymoses Petechiae Epistaxis Hemorrhage from throat Gangrene Shock Shortness of breath * Hemoptypsis unspecified, acute idiopathic pulmonary hemorrhage in infants, other Chest pain, unspecified Chest pain, other Abdominal pain Colic Abnormal coagulation profile Fracture of vault of skull Fracture of base of skull Fracture of face bones mandible open, closed Fracture of face bones molar and maxillary, orbital floor, other Other fracture, skull Multiple fractures, skull Fracture of vertebral column without mention of spinal cord injury, cervical Fracture of vertebral column without mention of spinal cord injury thoracic, lumbar sacrum and coccyx, unspecified Fracture of vertebral column with spinal cord injury Fracture of vertebral column with spinal cord injury unspecified open or closed Fractures of rib(s), closed Fracture of rib(s), open Fracture of pelvis, unspecified open or closed Fracture of trunk Fracture of clavicle Fracture of scapula Fracture of humerus Fracture of radius and ulna, upper end, open Fracture of radius and ulna, shaft, open Fracture of radius and ulna, lower end, open Fracture of radius and ulna, unspecified part, open Multiple fractures Fracture of neck of femur Fracture of unspecified part of neck of femur, closed or open Fracture of other and unspecified parts of femur Fracture of tibia and fibula Other multiple lower limb fractures Subarachnoid subdural, and extradural hemorrhage, following injury, other and specified intracranial hemorrhage following injury Traumatic pneumothorax and hemothorax Injury to heart and lung Injury to other and unspecified intrathoracic organs. Diaphragm with or without open wound into cavity Other specified intrathoracic, thoracic organs with or without open wound into cavity Multiple and unspecified intrathoracic organs with or without open wound into cavity Injury to gastrointestinal tract, stomach with or without mention of open wound into cavity Injury to gastrointestinal tract, small intestine, colon or rectum, other and unspecified sites with or without mention of open wound into cavity 5 of 7

6 Injury to liver Injury to spleen Injury to kidney Injury to pelvic organs Injury to other intra-abdominal organs Internal injury to unspecified or ill defined organs Injury to blood vessels of head and neck Injury to blood vessels of the thorax Injury to pulmonary blood vessels, other specified blood vessels of thorax Injury to blood vessels of abdominal aorta Injury to blood vessels of abdomen and pelvis, inferior vena cava, celiac and mesenteric, portal and splenic, renal, iliac, other Unspecified injury to blood vessel of abdomen, pelvis Injury to blood vessels of upper extremity Injury to blood vessels of lower extremity femoral saphenous Injury to blood vessels of lower extremity popliteal, tibial Injury to blood vessels of lower extremity unspecified, deep plantar, other specific blood vessels of lower extremity, unspecified site 920 Contusion of face, neck, and scalp (except eye) Contusion of eye and adnexa or trunk Contusion of back Contusion of genital, multiple sites of trunk, or unspecified part Contusion of upper limb, lower limb to include hip, thigh, knee, lower leg, ankle and foot (excluding toes) Contusion of toe, multiple sites of lower limb, unspecified part of lower limb, multiple sites not classified, unspecified site Crushing injury of face, neck, and scalp Crushing injury of external genitalia Crushing injury back, buttock, other Crushing injury multiple sites of trunk, unspecified site Crushing injury of upper limb shoulder, upper arm, elbow, forearm, wrist, hands; except fingers alone Crushing injury- fingers, multiple sites of upper limb, unspecified sites Crushing injury of lower limb hip, thigh, knee, lower leg, ankle, foot; excluding toes Crushing injury of toes, multiple sites of lower limb, unspecified Crushing injury of multiple and unspecified sites Injury, unspecified site Poisoning by anticoagulants Poisoning by anticoagulant antagonists Poisoning by natural blood and blood products Toxic effects of alcohol Snake venom Other and unspecified adverse effect of drug, medicinal and biological substances Other complications of internal (biological) synthetic, prosthetic device, implant and graft Iatrogenic cerebrovascular infarction or hemorrhage Hemorrhage or hematoma complicating a procedure Other vascular complications of medical care V12.3 Personal history of diseases of blood and blood forming organs V58.2 Admission for Transfusion of blood products V58.61 Long term (current use) of anticoagulants V58.83 Encounter for therapeutic drug monitoring 6 of 7

7 ICD-9-CM Codes That May Be Denied or Do Not Support Medical Necessity Generally, ICD-9-CM codes that are not listed in the ICD-9-CM Codes Covered by Medicare Program section will not be covered because they indicate that the tests are performed for screening purposes or because they do not support medical necessity. 7 of 7