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Coding Analysis for Labs (CAL) Tracking Sheet for Prothrombin Time (PT) (Addition of two ICD-9-CM diagnosis codes) (CAG-00428N)



CMS received an external request to add ICD-9-CM diagnosis code 786.50, Chest pain, unspecified to the list of diagnosis codes covered by Medicare under the National Coverage Determination (NCD) for Prothrombin Time (PT) at Section 190.17 of the Medicare National Coverage Determination Manual (NCDM).

The requestor's letter suggested that the addition of this code is consistent with the narrative of indications in Section 190.17 of the NCD Manual. Also, the addition of this code for coverage under 190.17 would bring that NCD policy into conformity with the list of codes approved for 190.16, partial thromboplastin time (PTT), in which the code 786.50 is included.

During internal review at CMS, we determined that the related code 786.51, Precordial pain, also seemed to flow from the narrative of 190.17. A portion of the 'Indications' section of the policy indicates a PT test might be useful in evaluating a patient with thrombosis such as a myocardial infarction.

Section 190.17 of the NCD manual indicates the PT test is an in-vitro laboratory test used to assess 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 coagulation factors may be related to decreased production or increased consumption. A PT test may be used to assess patients taking warfarin; assess 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; or 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.

CMS is seeking public comment on the proposal that two ICD-9-CM diagnosis codes, 786.50, Chest pain, unspecified, and 786.51, Precordial pain, flow from the existing narrative for conditions for which a PT test is reasonable and necessary. CMS may add these two ICD-9-CM diagnosis codes to the list of "ICD-9-CM Codes Covered by the Medicare Program" for the NCD for PT testing, as stated in Section 190.17 of the NCD Manual.

Diagnostic Laboratory Tests
Requestor Name(s)C. Anne Pontius, President, Clinical Laboratory Management Association
Formal Request Accepted and Review Initiated05/25/2011
Expected NCA Completion Date02/23/2012
Public Comment Period05/25/2011 - 06/24/2011
Proposed Decision Memo Due Date11/25/2011
Decision Memo Released07/21/2011
Lead Analyst(s)
Lead Medical Officer(s)
  • Jeffrey Roche, MD

May 25, 2011

CMS accepts a request to add ICD-9-CM diagnosis codes 786.50, chest pain unspecified, and upon additional review will also add 786.51, precordial pain, as ICD-9-CM diagnosis codes covered under the NCD on Prothrombin Time at section 190.17 of the Medicare NCD Manual.

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.

July 21, 2011

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