How To Use CPT Code 85290

CPT 85290 describes the clotting test for factor XIII, also known as fibrin stabilizing factor. 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 85290?

CPT 85290 can be used to describe the clotting test performed by a lab analyst to determine the presence of factor XIII, also known as fibrin stabilizing factor, in a patient’s serum. This test is ordered by clinicians to evaluate patients with a bleeding disorder who show normal prothrombin time (PT), normal partial thromboplastin time (PTT), and normal platelet count test results. It is an initial test used to diagnose factor XIII deficiency, which is the rarest factor deficiency and is associated with clot stabilization rather than clot formation.

2. Official Description

The official description of CPT code 85290 is: ‘Clotting; factor XIII (fibrin stabilizing).’ There are no additional notes or modifiers associated with this code.

3. Procedure

1. The lab analyst performs all technical steps to assess the presence of factor XIII in the patient’s serum.
2. The lab method may involve steps such as mixing the patient’s plasma with a factor XIII deficient substrate and evaluating the results with a chromogenic assay.

4. Qualifying circumstances

CPT 85290 is ordered by clinicians to evaluate patients with a bleeding disorder who show normal PT, normal PTT, and normal platelet count test results. It is used as an initial test to diagnose factor XIII deficiency, which is the rarest factor deficiency. This test is not limited to testing for a specific condition.

5. When to use CPT code 85290

CPT code 85290 should be used when a clinician orders a clotting test to assess the presence of factor XIII in a patient’s serum. It is appropriate to use this code when evaluating patients with a bleeding disorder who show normal PT, normal PTT, and normal platelet count test results. This test helps diagnose factor XIII deficiency, which is associated with clot stabilization.

6. Documentation requirements

To support a claim for CPT 85290, the clinician must document the following information:

• Reason for ordering the clotting test
• Results of the clotting test
• Any additional relevant information related to the patient’s condition

7. Billing guidelines

When billing for CPT 85290, ensure that the clotting test is performed by a lab analyst to determine the presence of factor XIII in the patient’s serum. There are no specific billing guidelines or modifiers associated with this code. However, it is important to distinguish the quantitative test for factor XIII activity (CPT 85290) from the qualitative test for factor XIII solubility screening (CPT 85291).

8. Historical information

CPT 85290 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A lab analyst performs a clotting test to determine the presence of factor XIII in a patient’s serum.
2. A clinician orders a clotting test for a patient with a bleeding disorder who shows normal PT, normal PTT, and normal platelet count test results.
3. A lab method involving mixing the patient’s plasma with a factor XIII deficient substrate is used to evaluate the results with a chromogenic assay.
4. A clinician orders a clotting test as an initial test to diagnose factor XIII deficiency in a patient.
5. A lab analyst performs a clotting test to assess the presence of factor XIII in a patient’s serum, who has shown symptoms of abnormal clot stabilization.
6. A clinician orders a clotting test to evaluate a patient with a suspected factor XIII deficiency, based on their medical history and symptoms.
7. A lab analyst performs a clotting test to confirm the presence of factor XIII in a patient’s serum, who has a family history of factor XIII deficiency.
8. A clinician orders a clotting test to assess the presence of factor XIII in a patient’s serum, who has experienced recurrent abnormal bleeding episodes.
9. A lab method involving a chromogenic assay is used to evaluate the results of a clotting test performed to determine the presence of factor XIII in a patient’s serum.
10. A clinician orders a clotting test to evaluate a patient with unexplained abnormal clotting tendencies, despite normal PT, normal PTT, and normal platelet count test results.