Pathology/Lab Coding Alert

Question: Why don't we get paid when our lab performs PT and PTT tests preoperatively for Medicare patients?


Texas Subscriber

Answer: Medicare will not pay for prothrombin time (PT, 85610, Prothrombin time) and partial thromboplastin time (PTT 85730, Thromboplastin time, partial [PTT]; plasma or whole blood) with preoperative examination diagnoses codes V72.81-V72.85 (Other specified examinations).

These five ICD-9 codes indicate that the physician ordered the tests without signs or symptoms. Thus, Medicare considers the tests "screenings" and, therefore, a noncovered service.

Way out: If 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).
 
Medicare will reimburse 85610 and 85730 for several conditions that potentially indicate bleeding problems, such as V15.1 (Other personal history presenting hazards to health; surgery to heart and great vessels).

Medicare will also cover the tests if the patient is taking anticoagulant medication (V58.61, Long-term [current] use of anticoagulants). The ordering physician must indicate one of these conditions before you can code it.
 
CMS' PT and PTT NCD is at www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=93.

Reader Questions and You Be the Coder were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark.