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PT/PTT testing prior to surgery

  1. #1
    Default PT/PTT testing prior to surgery
    Medical Coding Books
    Hello All:

    I need some help clarifying which diagnoses should be coded in order to support the PT and/or PTT testing which is done prior to surgical procedures incl. biopsies. This test would be done prior to the procedure in order to screen the patient for coagulation. Code V72.63 (Pre-procedural laboratory examination) is not on Medicare's list of approved codes (NCDs 190.16 and 190.17). In many cases the patient does not have a prior history of problems with coagulation.
    What would be the appropriate diagnosis coding in the following scenario: Patient X is seen for cancer. Dr. A (medical oncologist) sends patient X to Dr. B (surgeon) for a biopsy. Prior to the biopsy several tests are to be performed for surgical clearance, amongst those are the PT and/or PTT.
    Thanks so much for your insight!
    Karolina, CPC, CPMA, CEMC

  2. Default pt/ptt
    As far as I remmember v72.84 will cover PT/PTT.

  3. #3
    Default
    Thank you for your reply! Unfortunately V72.84 is not listed on either NCD as a accepted code.
    Karolina, CPC, CPMA, CEMC

  4. Default Please read this

  5. #5
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    Columbia, MO
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    Default
    you are correct the V72.84 is not a covered dx code for a PT/PTT in the article cited by boozaam:
    Testing prior to any medical intervention associated with a risk of bleeding and thrombosis (other than
    thrombolytic therapy) will generally be considered medically necessary only where there are signs or symptoms of a bleeding or thrombotic abnormality or a personal history of bleeding, thrombosis or a condition associated with a coagulopathy. Hospital/clinic-specific policies, protocols, etc., in and of themselves, cannot alone justify coverage.

    You cannot use a dx code the patient does not have so you will need to evaluate the value of theis test for the physician, if the patient's condition they are having the surgery for justifies performing the test then use that dx code otherwise either do not order the test or let the patient know up front that it is not covered and have them sign an ABN and then bill the patient, or do the test and write the charge off when it returns as non paid due to LCD.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
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    Smile
    Hey

    What about V58.83 & V58.61..?

    I think before surgery, for some diseases patient is on Coumadin/Anticoagulants. So in most of the surgeries 4-5 days before patient requested to stop Coumadin use. So for Current encounter patient is on anticoagulants. So we can use V58.83 & V58.61 along with V72.8* (Preoperative Exam) series code sets.

    Hope this helps!!!

    VJ

  7. #7
    Location
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    Quote Originally Posted by vj_tiwari View Post
    Hey

    What about V58.83 & V58.61..?

    I think before surgery, for some diseases patient is on Coumadin/Anticoagulants. So in most of the surgeries 4-5 days before patient requested to stop Coumadin use. So for Current encounter patient is on anticoagulants. So we can use V58.83 & V58.61 along with V72.8* (Preoperative Exam) series code sets.

    Hope this helps!!!

    VJ
    Yes that would be correct however the original poster stated the patient had no coagulation issues so there would not be a long term anticoagulant on board.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
    Default
    Thank you all for your insight!
    Karolina, CPC, CPMA, CEMC

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