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Coding Analysis for Labs (CAL) Tracking Sheet for Prothrombin Time (PT) NCD 190.17 (Addition of ICD-9-CM diagnosis code 197.7 Secondary Malignant Neoplasm of Liver) (CAG-00404N)



CMS received an external request to add ICD-9-CM diagnosis code 197.7 Secondary Malignant Neoplasm of Liver as an ICD-9-CM diagnosis code covered under the National Coverage Determination (NCD) on Prothrombin Time (PT) at section 190.17 of the Medicare National Coverage Determination Manual (NCDM).

Section 190.17 of the NCDM states that the PT test is one in-vitro laboratory test used to access coagulation. The PT assesses the extrinsic or tissue factor dependent pathway. The test also evaluates the common coagulation pathway involving all the reactions that occur after the activation of factor X. Extrinsic pathway factors are produced in the liver and their production is dependent on adequate vitamin K activity. Deficiencies of factors may be related to decreased production or increased consumption of coagulation factors. A PT test may be used to assess patients taking warfarin; patients with signs or symptoms of abnormal bleeding or thrombosis; evaluate patients with a history of a condition known to be associated with the risk of bleeding or thrombosis that is related to the extrinsic coagulation pathway; and assess the risk of hemorrhage or thrombosis in patients who are going to have a medical intervention known to be associated with increased risk of bleeding or thrombosis.

We believe that the ICD-9-CM diagnosis code 197.7-Secondary Malignant Neoplasm of Liver - may flow from this narrative description of the tests for which the policy contained in section 190.17 of the NCDM applies.

Diagnostic Laboratory Tests
Requestor Name(s)Sandra Palmer, RHIA, CCS; Ingham Regional Medical Center
Formal Request Accepted and Review Initiated10/14/2008
Public Comment Period10/14/2008 - 11/13/2008
Decision Memo Released11/24/2008
Comments for this CAL:View Public Comments
Lead Analyst(s)
Lead Medical Officer(s)
  • Jeffrey Roche, MD

October 14, 2008

CMS accepts a request to add ICD-9-CM diagnosis code 197.7 -Secondary Malignant Neoplasm of Liver as a ICD-9-CM diagnosis code covered under the National Coverage Determination (NCD) on Prothrombin Time (PT) at section 190.17.

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.

November 24, 2008

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