CMS Adds to PT Test Covered Dx Codes

The Centers for Medicare & Medicaid Services (CMS) has determined that ICD-9-CM codes 786.50 Chest pain, unspecified and 786.51 Precordial pain “flow from the existing narrative for conditions for which a prothrombin time (PT) test is reasonable and necessary.” Consequently, CMS is adding these two diagnosis codes to the list of codes covered by Medicare for the national coverage determination (NCD) for PT testing, as stated in section 190.17 of the NCD Manual.

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
  • 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

Prior to this decision, CMS posted a tracking sheet on the Medicare Coverage Database website and solicited public comments for 30 days on the appropriateness to add codes 786.50 and 786.51 to the PT NCD. According to CMS, no comments were received during the comment period.


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