How To Use CPT Code 85610

CPT 85610 is a code used for prothrombin time testing, which measures blood clotting time. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 85610 procedures.

1. What is CPT 85610?

CPT 85610 is a code used to represent the prothrombin time test, a laboratory procedure that measures the time it takes for blood plasma to clot. This test is commonly used to diagnose clotting disorders and to monitor the effectiveness of anticoagulant medications, such as Coumadin.

2. 85610 CPT code description

The official description of CPT code 85610 is: “Prothrombin time.”

3. Procedure

The 85610 procedure involves the following steps:

  1. A physician draws blood from a vein into a special test tube containing citrate, an anticoagulant that prevents clotting during transport.
  2. The blood sample is mixed and centrifuged to separate blood cells from plasma.
  3. The plasma is collected in a tube and placed on an automated instrument at 37°C.
  4. An excess amount of calcium is added to the plasma sample.
  5. A chemical of animal origin, known as tissue factor, is also mixed into the sample.
  6. The time the plasma sample takes to clot is measured optically.
  7. For patients on an anticoagulant, the analyst mixes the anticoagulant drug with the blood plasma or the patient is instructed to take the medicine before the test. The anticoagulant drug, when properly acting, causes a delay in clotting of blood.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 85610 services include those who:

  • Are suspected of having a clotting disorder.
  • Are taking anticoagulant medications and need to monitor their effectiveness.
  • Have a history of blood clotting issues or are at risk for developing them.
  • Are undergoing certain medical procedures that require monitoring of blood clotting time.

5. When to use CPT code 85610

It is appropriate to bill the 85610 CPT code when a prothrombin time test is performed to diagnose or monitor clotting disorders, or to assess the effectiveness of anticoagulant medications. This code should be used for each individual prothrombin time test performed on a patient.

6. Documentation requirements

To support a claim for CPT 85610, the following information needs to be documented:

  • Patient’s medical history and relevant clinical findings.
  • Indication for the prothrombin time test, such as suspected clotting disorder or monitoring of anticoagulant therapy.
  • Details of the blood draw, including the site of the venipuncture and any complications encountered.
  • Results of the prothrombin time test, including the clotting time and any abnormal findings.
  • Interpretation of the test results by the ordering physician, including any changes to the patient’s treatment plan based on the findings.

7. Billing guidelines

When billing for CPT code 85610, it is important to follow these guidelines:

  • Ensure that the documentation supports the medical necessity of the prothrombin time test.
  • Verify that the patient meets the qualifying circumstances for the test.
  • Include the appropriate diagnosis codes on the claim form to support the use of CPT 85610.
  • Bill for each individual prothrombin time test performed on a patient, even if multiple tests are done on the same day.

8. Historical information

CPT 85610 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2010, with the previous descriptor being “Prothrombin time.”

9. Similar codes to CPT 85610

Five similar codes to CPT 85610 and how they differentiate from CPT 85610 are:

  • CPT 85611: This code is used for prothrombin time tests that include a thromboplastin time test, which measures the time it takes for blood to clot in the presence of tissue factor and calcium.
  • CPT 85612: This code is used for partial thromboplastin time tests, which measure the time it takes for blood to clot in the presence of a partial thromboplastin reagent and calcium.
  • CPT 85613: This code is used for thrombin time tests, which measure the time it takes for blood to clot in the presence of thrombin.
  • CPT 85651: This code is used for sedimentation rate tests, which measure the rate at which red blood cells settle in a test tube over a specified period.
  • CPT 85730: This code is used for activated partial thromboplastin time tests, which measure the time it takes for blood to clot in the presence of an activator, partial thromboplastin reagent, and calcium.

10. Examples

Here are 10 detailed examples of CPT code 85610 procedures:

  1. A patient with a history of deep vein thrombosis (DVT) is prescribed an anticoagulant medication and requires regular prothrombin time testing to monitor the effectiveness of the medication.
  2. A patient presents with unexplained bruising and bleeding, and the physician orders a prothrombin time test to evaluate for a potential clotting disorder.
  3. A patient with atrial fibrillation is started on anticoagulant therapy and requires prothrombin time testing to ensure the medication is working effectively.
  4. A patient undergoing a surgical procedure with a known clotting disorder requires a prothrombin time test to assess their clotting status before surgery.
  5. A patient with a family history of clotting disorders presents with symptoms suggestive of a clotting disorder, and the physician orders a prothrombin time test to evaluate their clotting function.
  6. A patient on long-term anticoagulant therapy for a mechanical heart valve requires routine prothrombin time testing to monitor the effectiveness of their medication.
  7. A patient with liver disease presents with signs of abnormal bleeding, and the physician orders a prothrombin time test to assess their clotting function.
  8. A patient with a history of recurrent blood clots is started on a new anticoagulant medication and requires prothrombin time testing to monitor the effectiveness of the new medication.
  9. A patient with a known clotting disorder requires a prothrombin time test before undergoing a dental procedure to assess their risk of bleeding complications.
  10. A patient on anticoagulant therapy for a pulmonary embolism requires prothrombin time testing to ensure their medication is working effectively and to adjust the dosage if necessary.

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