How To Use CPT Code 85250

CPT 85250 describes the clotting test performed by a lab analyst to determine the presence of factor IX, also known as PTC or Christmas factor, in a patient’s serum. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 85250?

CPT 85250 can be used to describe the clotting test performed by a lab analyst to assess the presence of factor IX, also called PTC or Christmas factor, in a patient’s serum. This test helps in diagnosing coagulation factor IX deficiency associated with hemophilia B, also known as Christmas disease. It is often ordered when investigating the cause of a prolonged partial thromboplastin time (PTT) test.

2. Official Description

The official description of CPT code 85250 is: ‘Clotting; factor IX (PTC or Christmas).’ This code represents the lab analyst’s assessment of the presence of factor IX in the patient’s serum using various methods, such as mixing the patient’s plasma with a factor IX deficient substrate or triggering coagulation with a partial thromboplastin time reagent and calcium.

3. Procedure

1. The lab analyst performs all technical steps to assess the presence of factor IX in the patient’s serum.
2. The lab method may involve mixing the patient’s plasma with a factor IX deficient substrate and evaluating the results with a chromogenic assay.
3. Alternatively, the lab analyst may add a partial thromboplastin time reagent and calcium to trigger coagulation and optically measure clot formation.

4. Qualifying circumstances

CPT 85250 is typically ordered when investigating the cause of a prolonged PTT test or diagnosing coagulation factor IX deficiency associated with hemophilia B (Christmas disease). It is not limited to testing for a specific condition but is used to assess the presence of factor IX in the patient’s serum.

5. When to use CPT code 85250

CPT code 85250 should be used when a clotting test is performed to determine the presence of factor IX in the patient’s serum. It is appropriate to use this code when investigating the cause of a prolonged PTT test or diagnosing coagulation factor IX deficiency associated with hemophilia B (Christmas disease).

6. Documentation requirements

To support a claim for CPT 85250, the documentation should include:

• Reason for ordering the clotting test
• Details of the lab method used to assess the presence of factor IX
• Date and time of the test
• Results of the clotting test
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 85250, ensure that the clotting test is performed by a lab analyst. It is important to follow the specific guidelines provided by the payer regarding the reporting of this code. Some payers may also separately reimburse for specimen collection using a code such as 36415 for venipuncture.

8. Historical information

CPT 85250 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performs a clotting test to assess the presence of factor IX in a patient’s serum, helping diagnose coagulation factor IX deficiency associated with hemophilia B.
2. During a prolonged PTT test, a lab analyst performs a clotting test to investigate the cause, assessing the presence of factor IX in the patient’s serum.
3. A patient with a suspected coagulation factor IX deficiency undergoes a clotting test, performed by a lab analyst, to confirm the diagnosis.
4. As part of a comprehensive coagulation profile, a lab analyst assesses the presence of factor IX in a patient’s serum.
5. A physician orders a clotting test to evaluate the presence of factor IX in a patient’s serum, aiding in the diagnosis of Christmas disease.
6. During a routine check-up, a lab analyst performs a clotting test to assess the presence of factor IX in a patient’s serum, ensuring normal coagulation function.
7. A patient with a prolonged PTT test undergoes a clotting test to determine if factor IX deficiency is the cause.
8. Following a surgical procedure, a lab analyst performs a clotting test to assess the presence of factor IX in the patient’s serum, monitoring for any coagulation abnormalities.
9. A patient with a family history of Christmas disease undergoes a clotting test to evaluate the presence of factor IX in their serum.
10. As part of a hematology workup, a lab analyst performs a clotting test to assess the presence of factor IX in a patient’s serum.