Prothrombin Time (PT) NCD 190.17 (Addition of ICD-9-CM diagnosis code 197.7 Secondary Malignant Neoplasm of Liver)

Section 190.17 of the NCDM is entirely correct in its description of the PT test and its uses to the extent that its uses are described. However, this description is not complete. The PT test plays a vital role in the determination of the severity of chronic liver disease. The index of liver disease severity is most often determined using a MELD score, which stands for model for end-stage liver disease. The MELD score was instituted in 2002 as a non-subjective means to determine mortality in patients with liver disease and to consistently prioritize the allocation of organs for liver transplantation. This score is calculated based on a simple formula that takes into account 3 parameters, the most important of which is the PT/INR. The other parameters include total bilirubin and serum creatinine. The PT test is an important indicator for liver disease severity over a broad range of etiologies. Therefore, the 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) is fully justified, and we urge CMS to approve the request and revise the NCD accordingly.

References:

Marlar RA. Hepatology 2007;46:293-294

Kamath PS, Wiesner RH, Malinchoc M, et al. Hepatology 2001;33:464.

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