Otolaryngology Coding Alert

Question: A colleague thinks that our otolaryngologists shouldn't report PT and PTT tests preoperatively to Medicare. Is the coder right?

Texas Subscriber

Answer: Although you should not routinely bill prothrombin time (PT) (85610-QW, Prothrombin time; CLIA-waived test) and partial thromboplastin time (PTT) (85730-QW, Thromboplastin time, partial [PTT]; plasma or whole blood) tests to Medicare, you should charge medically necessary labs.
 
CMS will not pay for PT and PTT tests with preoperative examination diagnoses V72.81-V72.85 (Other specified examinations). These five ICD-9 codes indicate the otolaryngologist ordered the tests without signs or symptoms. Thus, Medicare considers the tests "screenings" and, therefore, a noncovered service.
 
Out: If, however, the patient has a sign, symptom or past history of disease that indicates an increased surgical risk, Medicare will cover the PT and PTT tests, states the national coverage determination (NCD). CMS will reimburse 85610 and 85730 for several conditions that potentially indicate bleeding problems, such as V15.1 (Personal history of surgery to heart and great vessels). Medicare will also cover the tests if the patient is taking anti-coagulant medication (V58.61, Long-term [current] use of anticoagulants).
 
CMS' PT and PTT national coverage determination is at www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=93.