PROTHROMBIN TIME - 85610 - Sanford Laboratories

1 PROTHROMBIN time 10-10 PROTHROMBIN time Source: Program Memorandum AB-02-110, Effective 11-25-02; Medicare NCD Manual, July 2003 Release; October 2003 Release; January 2004 Release; October 2004 Release; January 2005 Release; October 2005 Release; October 2006 Release; January 2007 Release; Medicare Trans. 1531, Effective 7-1-08, October 2008 Release, April 2009 Release, October 2009 Release, October 2010 Release CMS (Medicare) has determined that PROTHROMBIN time (CPT Code 85610 ) 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).

2 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. Note: Since the INR is a calculation, it will not be paid separately from or in addition to the PT, but is considered part of the conventional PROTHROMBIN time , 85610 .

3 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.

4 Nephrosonephritis Blackwater fever Schistosomiasis Clonorchiasis Fascioliasis 124 Trichinosis Hirudiniasis 135 Sarcoidosis Malignant neoplasm of small intestine, including duodenum Malignant neoplasm of liver and intrahepatic bile ducts Malignant neoplasm of gallbladder and extrahepatic bile ducts Malignant neoplasm of pancreas Malignant neoplasm of bladder, kidney, and other and unspecified urinary organs Liver, specified as secondary malignant neoplasm Secondary malignant neoplasm, kidney or other urinary organs NCD1 of 8 PROTHROMBIN time 10-10 Lymphosarcoma and reticulosarcoma Other malignant neoplasms of lymphoid and histiocytic tissue Malignant carcinoid tumors of other and unspecified sites Secondary neuroendocrine tumor.

5 Unspecified site Secondary neuroendocrine tumor of distant lymphnodes Secondary neuroendocrine tumor of liver Secondary neuroendocrine tumor of bone Secondary neuroendocrine tumor of peritoneum Secondary Merkel cell carcinoma Secondary neuroendocrine tumor of other sites Benign neoplasm of kidney and other urinary organs kidney (except pelvis), renal pelvis, ureter, bladder Benign neoplasm of kidney; other specified sites of urinary organs urethra, paraurethral glands Benign neoplasm of kidney; urinary organs site unspecified Polycythemia vera Neoplasm of uncertain behavior plasma cells, histocytic and mast cells Other lymphatic and hematopoietic tissues, PTLD Neoplasm of unspecified nature, bladder or other genitourinary organs Neoplasm of unspecified nature, site unspecified Hemorrhage and infarction of thyroid Secondary diabetes mellitus with renal manifestations, not stated as uncontrolled or unspecified Secondary diabetes mellitus with ophthalmic manifestations.

6 Uncontrolled Diabetic with renal manifestations Other and unspecified protein/calorie malnutrition Deficiency of Vitamin K Unspecified vitamin deficiency Disorders of plasma protein metabolism Disorders of iron metabolism Disorders of porphyrin metabolism Amyloidosis * Hereditary hemochromatosis, hemochromatosis due to repeated red blood cell transfusions, other hemochromatosis, other disorders of iron metablolism Iron deficiency anemia, secondary to blood loss - chronic Iron deficiency anemia, unspecified Other deficiency anemias pernicious, other vitamin B12 Unspecified Deficiency Anemia, NOS Sideroblastic anemia or acute posthemorrhagic anemia Coagulation defects Purpura and other hemorrhagic conditions Primary thrombocytopenia * Posttranfusion purpura, other secondary thrombocytopenia Thrombocytopenia secondary, unspecified / other specified hemorrhagic conditions, unspecified hemorrhagic conditions Primary hypercoagulable state Arteriosclerotic dementia 325 Phlebitis and thrombophlebitis of intracranial venous sinuses Hemiplegia NOS Hemophthalmos.

7 Except current injury Retinal vasculitis Retinal vascular occlusion Hemorrhagic detachment of retinal pigment epithelium Retinal hemorrhage Choroidal hemorrhage and rupture, detachment 2 of 8 PROTHROMBIN time 10-10 Unspecified Visual Disturbances Conjunctival hemorrhage Hemorrhage of eyelid Orbital hemorrhage Hemorrhage in optic nerve sheaths Disorders of optic chiasm associated with vascular disorders Disorders of visual pathways associated with vascular disorders Disorders of visual cortex associated with vascular disorders Vitreous hemorrhage Hematoma of auricle or pinna Vertigo of central origin

8 Labyrinthine dysfunction, unspecified Diseases of the mitral valve Rheumatic aortic stenosis Rheumatic aortic stenosis with insufficiency Diseases of mitral and aortic valves Diseases of other endocardial structures Rheumatic myocarditis Other and unspecified rheumatic heart diseases , , Hypertensive Renal Disease with renal failure , , Hypertensive Heart and Renal Disease with renal failure Acute myocardial infarction Intermediate coronary syndrome Acute coronary occlusion without myocardial infarction, coronary insufficiency, subendocardial ishcemia Angina pectoris Coronary atherosclerosis Coronary artherosclerosis due to lipid rich plaque Other specified forms of chronic ischemic heart disease Chronic ischemic heart disease, unspecified Pulmonary heart disease; acute cor pulmonale Pulmonary heart disease; iatrogenic pulmonary embolism and infarction Septic pulmonary embolism Acute pulmonary heart disease.

9 Other Chronic pulmonary heart disease, unspecified Hemopericardium Mitral, aortic valve disorder Endocarditis, valve unspecified, unspecified cause Cardiomyopathy Cardiac dysrhythmias; tachycardia Atrial fibrillation and flutter, ventricular fibrillation and flutter, cardiac arrest, premature beats, other specified cardiac dysrhythmias Cardiac dysrhythmia, unspecified Heart failure Ill-defined descriptions and complications of heart disease Other certain sequelae of myocardial infarction, not elsewhere classified 430-431 Hemorrhage subarachnoid, intracerebral Other and unspecified intracranial hemorrhage Occlusion and stenosis of precerebral arteries Occlusion of cerebral arteries Transient cerebral ischemia 436 Acute, but ill-defined cerebrovascular disease Cerebral atherosclerosis.

10 Other generalized ischemic cerebrovascular disease 3 of 8 PROTHROMBIN time 10-10 Nonpyogenic thrombosis of intracranial venous sinus Atherosclerosis Dissection of aorta unspecified, thoracic, abdominal, thoracoabdominal Aortic aneurysm thoracic (ruptured/ without mention of rupture), abdominal (ruptured/ without mention of rupture), aortic of unspecified site (ruptured/ without mention of rupture), thoracoabdominal (ruptured/ without mention of rupture) Other peripheral vascular disease Raynaud s, thromboangitis Other arterial dissection, other specified peripheral vascular disease Peripheral vascular disease, unspecified Arterial embolism and thrombosis Stricture of artery, rupture of artery Arteritis, unspecified Hereditary hemorrhagic telangiectasia Other and unspecified capillary diseases Phlebitis and thrombophlebitis Phlebitis and thrombophlebitis of deep vessels of lower extremities Phlebitis and thrombophlebitis of lower extremities.