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

CMS received an external 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).

Section 190.17 of the NCDM states that the PT test is one in-vitro laboratory test used to access coagulation. The PT assesses the extrinsic or tissue factor dependent pathway. The test also evaluates the common coagulation pathway involving all the reactions that occur after the activation of factor X. Extrinsic pathway factors are produced in the liver and their production is dependent on adequate vitamin K activity. Deficiencies of factors may be related to decreased production or increased consumption of coagulation factors. A PT test may be used to assess patients taking warfarin; 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; and 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.

We believe that the ICD-9-CM diagnosis code 197.7-Secondary Malignant Neoplasm of Liver - may flow from this narrative description of the tests for which the policy contained in section 190.17 of the NCDM applies.

October 14, 2008

November 24, 2008