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85610 CPT Code For Prothrombin Time Test | Description & Billing Guide

CPT code 85610 can be billed when the physician furnishes a “Prothrombin time” test. Below are the description and billing guidelines for the 85610 CPT code for prothrombin time test.

What Is A Prothrombin Time Test?

The prothrombin time test can be reported with CPT code 85610 and calculates the blood clot’s time. It aids in identifying the effectiveness of drugs for thinning blood or preventing clots and also plays a significant role to detects deficiencies in the proteins necessary for clotting.

What Is CPT Code 85610 Used For?

A bleeding disorder also refers to hemophilia and causes dysfunction in the coagulation factors of the patient. Several other reasons may cause this condition, such as vitamin K deficiency, some medications, and liver disease may also promote abnormal clot formation.

The following are the symptoms when the physician bill CPT code 85610;

  • swollen or painful joints;
  • heavy menstrual periods;
  • easy bruising;
  • bleeding that won’t stop, even after applying pressure to the wound;
  • blood in the urine; and/or
  • nosebleed.

The Prothrombin time test (CPT code 85610) procedure may refer to as prothrombin, simply PT, or as a prothrombin time (PT). The physician extract plasma specimens to measure the PT. The prothrombin time may extend when coagulation factors II, V, VII, or X deficiencies are present.

The patient must take medicine before the test to determine the level. The different chemical agents, such as calcium, add to the plasma sample, and the time calculates to determine the clotting time.

CPT 85610 can be billed to evaluate drug effectiveness, such as a blood thinner agent or an anticoagulant drug like Coumadin. 

The physician often orders a Prothrombin time CPT code procedure to determine the effectiveness of the anticoagulant drug Coumadin or warfarin, prescribed to patients who have had blood clots or myocardial infarction.

The average blood clot range is about 1 to 13 seconds. It considers abnormal or longer when it takes more than 13 seconds; if it is less than 10 seconds, blood clots faster than usual.

The procedure described by CPT code 85610 can calculate the international normalized ratio (INR) from 0.8 to 1.1 (normal range).

A lower INR means blood clots more quickly than usual, and a higher means blood clots slowly. Healthy people may have 1.1 or below is considered normal, and the individual taking warfarin for disorders such as a blood clot in the leg or lung or atrial fibrillation may have 2.0 to 3.0. 

The following are the conditions when a doctor orders the test described by the 85610 CPT code for prothrombin time:

If a patient has surgery and may need confirmation regarding the blood clotting process, procedure code CPT 85610 may require determining the clotting process.

Suppose the patient suffers from heavy nose bleeding or developing bruises or may have a deep cut that doesn’t stop bleeding. The physician may perform CPT code 85610 to treat the problem. 

The patient may have symptoms such as bleeding disorders, and it may need to identify the PT first for further proceedings. 

If the patient consumes a large amount of vitamin k from various sources such as Green tea, Beef and pork liver, Turnip greens, Soybean products, Kale, and Broccoli, It may affect the test results of PT. 

85610 CPT Code Description

CPT code 85610 can be billed for the service when the physician performs the “Prothrombin time” test.

The CPT code for Prothrombin time is described in CPT’s manual by CPT 85610 and its official description is: “Prothrombin time.”

How To Bill CPT 85610

Documentation must establish the medical necessity and appropriateness of CPT 85610. The patient’s condition must reflect the severity and illness of the patient. The ICD 10 codes may confirm by NCD or LCD for efficient and effective payments from the insurance. The following are the payable Dx codes:

A63.0, C53.8, C53.9, B07.0, B97.7, C53.0, D06.7, D06.9, D26.0, C53.1, , D06.0, D06.1, R85.81, R87.810, R87.811, Z11.51

If Agglutinins (86000, 86156-86157) perform in conjunction with CPT 85610, it is appropriate to report without any modifier or check the proper third-party payors guidelines.

If Antiplasmin (85410) performs in addition to CPT 85610, it is appropriate to report CPT 85610 without any modifier or check the proper third-party payors guidelines.

If Antithrombin III (85300-85301) performs in combination with CPT 85610, it is appropriate to report without any modifier or check the insurance if it applies. 

If Blood banking procedures (86850-86999) perform in combination with CPT 85610, It is appropriate to report without any modifier or check the insurance guidelines if suitable. 

Does CPT Code 85610 Need A QW Modifier?

Modifier QW is appropriate to report with CPT 85610 laboratory procedure or service if it is a Clinical Laboratory Improvement Amendments (CLIA) approved code.

Is CPT Code 85610 A CLIA Waived Test?

A national coverage determination (NCD) exists for CPT code 85610, and it is appropriate to check the NCD for the coverage and decision of the claim. It may use the CLIA system.

Does CPT code 85610 Need A Modifier?

If evaluation and management services (CPT 99201 – CPT 99499) perform in combination with the CPT code for prothrombin time test, it is appropriate to report modifier 25 with the E/M service or check the payor guidelines if applicable. 

It is inappropriate to report CPT code 85610 with modifier 26 or TC component, and it is appropriate to bill modifier 26 and TC when feasible with laboratory procedure codes. 

CPT 85610 is inappropriate to report with the other laboratory and pathology procedure codes, including prothrombin time CPT code 85610.

The physician performs the surgery and laboratory and pathology procedures included in the surgical practice. It is inappropriate to report CPT codes CPT 80000 – CPT 89999 separately. It is wrong to report multiple codes for one procedure when one principle does not exist. 

Modifier 59 applies with CPT 85610 when the physician performs the prothrombin time test and bundles this with another procedure on the same date.   

Modifier X {E, P, S, U} is applicable instead of Modifier 59 with CPT code 85610 when service bills to Medicare insurance. It divides the modifier into four parts for further specification of the procedure. 

Modifier 22 applies to CPT 85610 when services perform longer than usual and take extra resources during the procedure. 

Modifier 52 applies when the physician does not complete the immunization service and terminates due to unavoidable circumstances. 

Modifier 90 applies to the CPT code for prothrombin time test when the physician sends the specimen to the outside lab or referenced lab. If the physician sends the samples to the reference or outside the lab, It is appropriate to report the reference lab service with modifier 90.

Modifier 91 applies to CPT code 85610 when the physician repeats the prothrombin time test procedure on the same day on the same patient. If the physician performs the PT test twice on the same service date, it is appropriate to report with modifier 91.

If physicians believe Medicare will deny such service, reporting with a GA modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and CPT 85610 must apply the GA modifier to that service.

How Much Does Medicare Reimburse For CPT 85610?

A maximum of four units can be a bill on the same service date of CPT 85610. In contrast, the three units allow when documentation supports the medical necessity of the service.  

The cost of CPT code 85610 is $4.29 when performed in the facility and non-facility. In contrast, the reimbursement CPT 85610 with modifier QW is $4.29 when performed in the facility and non-facility.

Example 1

A 21-year-old male presents to the office with no significant past medical history or personal history. He is now with urine in the blood. The patient did not take any medication to resolve this issue and has a healthy lifestyle.

The physical exam was unremarkable. There is no swelling in both the upper and lower extremity. 

The patient denies headache, nausea, vomiting, dizziness, tingling, and urinary bladder issues.

The physician orders the CT and MRI of the abdomen region and laboratory test to determine the cause of urine in the blood. The test result shows abnormal findings if the prothrombin time test. The physician prescribes the medication to efficiently the blood clotting process.

A prothrombin time test is used to determine the cause of urine in the blood. Therefore CPT code 85610 can be billed.

Example 2 

A 26-year-old male presents to the office with no significant past medical history or personal history. He is now with a nosebleed. The patient took no medication to resolve the nosebleed and maintain a healthy lifestyle. 

The patient denies dizziness, tingling, headache, nausea, vomiting, and urinary bladder issues. The physical exam reveals bruising in both the upper and lower extremities.

The physician orders the CT and MRI of the Head region and laboratory test to determine the cause nose bleed. The test result shows abnormal findings if the PT tests. The physician prescribes the medication to stop nose bleeding and asks for follow-up treatments.

A prothrombin time test is used to determine the cause of the nosebleed. Therefore prothrombin time CPT code 85610 can be billed.

Example 3 

A 36-year-old male presents to the ED with no significant past family history or personal history. He is now with swollen or painful joints. The patient has 8 out of 10 pain severity. The patient did not take any pain medication and had a healthy lifestyle.

The patient denies dizziness, tingling, headache, nausea, vomiting, and urinary bladder issues. The physical exam reveals swollen knee and ankle joints.

The physician ordered a CT and MRI of the Knee region and a laboratory test to determine the cause of swollen joints. The test result shows abnormal findings related to anemia. The physician prescribes the medication to control the blood disorders. 

A prothrombin time test is used to determine the cause of swollen joints. Therefore the 85610 CPT code and a CPT code for MRI knee can be reported.

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