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Coding Analysis for Labs (CAL) Tracking Sheet for Prothrombin Time (Addition of ICD-9-CM 289.81, Primary Hypercoagulable State as a Covered Indication) (CAG-00328N)

CMS received an external request to add Primary hypercoagulable state, ICD-9-CM 289.81, to the covered indication code list for the Prothrombin Time (PT) NCD at 190.17 of the NCD Manual.

ICD-9-CM 289.81 was created after the development of the ICD-9-CM Codes Covered By Medicare list for the PT NCD, and is not included in the current list. The narrative covered indications for the PT NCD include hypercoagulable state.

Consequently, we believe code 289.81, Primary hypercoagulable state, flows from the narrative. We are seeking public comment on the addition of code 289.81 to the ICD-9-CM Codes Covered By Medicare

The regulation for maintaining code lists in the negotiated NCDs for clinical diagnostic laboratory services states that codes on the covered list flow from the existing NCD narratives of covered indication. The regulation was published February 25, 2005 in the Federal Register, Vol.70, No. 37 and can be viewed at

Diagnostic Laboratory Tests
Requestor Name(s)Debbie Beedlow, CMC, Hematology and Oncology Consultants
Requestor Letter(s)View Letter
Formal Request Accepted and Review Initiated04/18/2006
Expected NCA Completion Date07/18/2006
Public Comment Period04/18/2006 - 05/18/2006
Decision Memo Released05/31/2006
Comments for this CAL:View Public Comments
Lead Analyst(s)
  • Maria Ciccanti
Lead Medical Officer(s)
  • James Rollins, MD, MSHA, PhD

April 18, 2006

CMS accepts a request to add ICD-9-CM code 289.81 as a covered indication in the Prothrombin Time national coverage determination list of covered indications.

The 30-day public comment period begins with this date, and ends after 30 calendar days. CMS considers all public comments, and is particularly interested in clinical studies and other scientific information relevant to the test under consideration.

May 31, 2006

Posted decision memo.