LCD/NCD Portal

NCD190.16 PARTIAL THROMBOPLASTIN TIME (PTT)

 

 

Effective Date of this Version

1/1/2003

 

 

Benefit Category

 

• Diagnostic Laboratory Tests.

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

 

Item/Service Description

 

• Basic plasma coagulation function is readily assessed with a few simple laboratory tests:

o PTT.

o Prothrombin time (PT).

o Thrombin time (TT).

o Quantitative fibrinogen determination.

• The PTT test is an in vitro laboratory test used to assess the intrinsic coagulation pathway and monitor heparin therapy.

 

 

Indications and Limitations of Coverage

 

Indications

 

• The PTT is most commonly used to quantitate the effect of therapeutic unfractionated heparin and to regulate its dosing.

o Except during transitions between heparin and warfarin therapy, in general both the PTT and PT are not necessary together to assess the effect of anticoagulation therapy.

o PT and PTT must be justified separately.

• A PTT may be used to assess patients with signs or symptoms of hemorrhage or thrombosis.

o For example:

 Abnormal bleeding.

 Hemorrhage or hematoma petechiae or other signs of thrombocytopenia that could be due to disseminated intravascular coagulation.

 Swollen extremity with or without prior trauma.

• A PTT may be useful in evaluating patients who have a history of a condition known to be associated with the risk of hemorrhage or thrombosis that is related to the intrinsic coagulation pathway.

o Such abnormalities may be genetic or acquired.

 For example:

 Dysfibrinogenemia.

 Afibrinogenemia (complete).

 acute or chronic liver dysfunction or failure, including Wilson's disease

 Hemophilia.

 Liver disease and failure.

 Infectious processes.

 Bleeding disorders.

 Disseminated intravascular coagulation.

 Lupus erythematosus.

 Other conditions associated with circulating inhibitors, e.g.,

 Factor VIII Inhibitor.

 Lupus-like anticoagulant.

 Sepsis.

 Von Willebrand's disease.

 Arterial and venous thrombosis, including the evaluation of hypercoagulable states.

 Clinical conditions associated with nephrosis or renal failure.

 Other acquired and congenital coagulopathies as well as thrombotic states.

• A PTT may be used to assess the risk of thrombosis or hemorrhage in patients who are going to have a medical intervention known to be associated with increased risk of bleeding or thrombosis.

o An example is as follows: evaluation prior to invasive procedures or operations of patients with personal or family history of bleeding or who are on heparin therapy.

 

Limitations

 

• The PTT is not useful in monitoring the effects of warfarin on a patient's coagulation routinely.

o However, a PTT may be ordered on a patient being treated with warfarin as heparin therapy is being discontinued.

o A PTT may also be indicated when the PT is markedly prolonged due to warfarin toxicity.

• The need to repeat this test is determined by changes in the underlying medical condition and/or the dosing of heparin.

• Testing prior to any medical intervention associated with a risk of bleeding and thrombosis (other than thrombolytic therapy) will generally be considered medically necessary only where there are signs or symptoms of a bleeding or thrombotic abnormality or a personal history of bleeding, thrombosis or a condition associated with a coagulopathy.

o Hospital/clinic-specific policies, protocols, etc., in and of themselves, cannot alone justify coverage.

• Note: Scroll down for links to the quarterly Covered Code Lists (including narrative).

 

 

Cross Reference

 

• Also see the Medicare Claims Processing Manual, Chapter 120, Clinical Laboratory Services Based on Negotiated Rulemaking.

 

 

Coverage Transmittal Link

 

• http://cms.gov/transmittals/downloads/R17NCD.pdf

 

 

Other

 

Covered Code Lists (including narrative)

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Changes to Lab NCD Edit Software

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Coding Analyses for Labs (CALs)

 

• This NCD has been or is currently being reviewed under the National Coverage Determination process.

• The following are existing associations with CALs, from the Coding Analyses for Labs database.

• Original consideration for Partial Thromboplastin Time (Addition of ICD-9-CM 289.81, Primary Hypercoagulable State as a covered indication) (CAG-00327N)

• Original consideration for Partial Thromboplastin Time (PTT) (Addition of ICD-9-CM V58.83, Encounter for therapeutic drug monitoring, as a covered indication) (CAG-00338N)

• Original consideration for Prothrombin Time (PT) and Partial Thromboplastin Time (PTT) tests (Removal of Unspecified Joint Replacements) (CAG-00246N)

• Original consideration for Prothrombin Time and Partial Thromboplastin Time (Revision of ICD-9-CM Codes for Pre-operative Examinations) (CAG-00184N)

• Original consideration for Prothrombin Time and Partial Thromboplastin Time (Revision of ICD-9-CM Codes for Swelling of Limb) (CAG-00201N)

 

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