Coding Analysis for Labs (CAL) Tracking Sheet

Prothrombin Time (PT) and Partial Thromboplastin Time (PTT) tests (Removal of Unspecified Joint Replacements)

CAG-00246N

Issue

[Coding determinations made as part of the Coding Analysis for Laboratory (CAL) process do not constitute National Coverage Determinations (NCDs), but only serve to provide clarification on codes that are covered under a particular laboratory negotiated NCD.]

The current national coverage determinations (NCDs) for PT and PTT include ICD-9-CM code V43.60, Unspecified joint replaced by other means, in the list of ICD-9-CM Codes Covered by Medicare. It is not evident that this code flows from anything included in the narrative covered indications for these tests. Coverage of this unspecified joint replacement without coverage of specified joint replacements is confusing. We will be reviewing this code more carefully with the benefit of public comment to make a determination if they should be removed from the list of covered diagnoses.

Benefit Category

Diagnostic Laboratory Tests

Requestor Information

Requestor Name Requestor Letter
Internally generated N/A
N/A

Important Dates

Formal Request Accepted and Review Initiated
06/24/2004
Expected CAL Completion Date
09/24/2004
Public Comment Period
06/24/2004 - 07/24/2004
Proposed Decision Memo Due Date
Proposed Decision Memo Released
Proposed Decision Memo Public Comment Period
Decision Memo Released
07/27/2004

Contacts

Lead Analysts
Jackie Sheridan-Moore
Lead Medical Officers

Medicare Benefit Category Determination Date

Actions Taken

June 24, 2004

Tracking sheet posted to the Internet.

July 27, 2004

Posted coding analysis.

November 26, 2004

Published implementing instructions  in transmittal 380 or pub 100-4 (CR3429)