Prothrombin Time (Addition of ICD-9-CM 289.81, Primary Hypercoagulable State as a Covered Indication)

CMS received an external request to add Primary hypercoagulable state, ICD-9-CM 289.81, to the covered indication code list for the Prothrombin Time (PT) NCD at 190.17 of the NCD Manual.

ICD-9-CM 289.81 was created after the development of the ICD-9-CM Codes Covered By Medicare list for the PT NCD, and is not included in the current list. The narrative covered indications for the PT NCD include hypercoagulable state.

Consequently, we believe code 289.81, Primary hypercoagulable state, flows from the narrative. We are seeking public comment on the addition of code 289.81 to the ICD-9-CM Codes Covered By Medicare

The regulation for maintaining code lists in the negotiated NCDs for clinical diagnostic laboratory services states that codes on the covered list flow from the existing NCD narratives of covered indication. The regulation was published February 25, 2005 in the Federal Register, Vol.70, No. 37 and can be viewed at http://www.cms.hhs.gov/Medicare/Coverage/CoverageGenInfo/LabNCDsICD10.html#TopOfPage.

April 18, 2006

May 31, 2006