MEDICAL POLICY
For use with the UnitedHealthcare Laboratory Benefit Management Program, administered by BeaconLBS
PARTIAL THROMBOPLASTIN TIME (PTT)
Policy Number: CMP - 005
Effective Date: January 21, 2017
Table of Contents
BACKGROUND
POLICY
REFERENCES
POLICY HISTORY/REVISION HISTORY
Page
1
3
4
4
INSTRUCTIONS FOR USE
This Medical Policy provides assistance in interpreting UnitedHealthcare benefit plans. When deciding coverage,
the enrollee specific document must be referenced. The terms of an enrollee's document (e.g., Certificate of
Coverage (COC) or Summary Plan Description (SPD)) may differ greatly. In the event of a conflict, the enrollee's
specific benefit document supersedes this Medical Policy. All reviewers must first identify enrollee eligibility, any
federal or state regulatory requirements and the plan benefit coverage prior to use of this Medical Policy. Other
Policies and Coverage Determination Guidelines may apply. UnitedHealthcare reserves the right, in its sole
discretion, to modify its Policies and Guidelines as necessary. This Medical Policy is provided for informational
purposes. It does not constitute medical advice.
UnitedHealthcare may also use tools developed by third parties, such as the MCG™ Care Guidelines, to assist us in
administering health benefits. The MCG™ Care Guidelines are intended to be used in connection with the
independent professional medical judgment of a qualified health care provider and do not constitute the practice
of medicine or medical advice.
BACKGROUND
The activated partial thromboplastin time (aPTT) is a laboratory test that evaluates the hemostatic system. The
assay reports, in seconds, the time required for clotting to occur after addition of phospholipid, an intrinsic pathway
activator and calcium to patient plasma. The aPTT reflects the function of the intrinsic and common coagulation
pathways. Defects in fibrinogen, prothrombin, factor V, factor X, factor VIII, factor IX, factor XII, prekallikrein, and
high molecular weight kininogen will prolong the clotting time. The test is used clinically to monitor heparin
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therapy, to presurgically evaluate patients, to investigate a bleeding or thrombotic tendency, and to evaluate
disorders such as cancer coagulopathy.
The aPTT is used most commonly to monitor heparin therapy. Heparin is a parenteral anticoagulant used to
prevent and treat thromboembolism. Heparin is used in the outpatient setting in pregnant patients in whom
warfarin therapy is a contraindicated and in hospitalized patients such as those undergoing cardiopulmonary
bypass surgery. Except during transitions between heparin and warfarin therapy, in general both the PTT and PT
are not necessary together to assess the effect of anticoagulation therapy. PT and PTT must be justified separately.
The universal use of aPTT in presurgical screening is controversial, but when patients present with a family or
personal history that points to a possible coagulation disorder, or when there is a history of liver disease,
malabsorption or malnutrition, preoperative evaluation of aPTT, along with prothrombin time (PT) is indicated.
Testing is also justified when a history cannot be obtained.
The aPTT is also used in combination with the PT and platelet count in the evaluation of a bleeding tendency.
Disorders of the coagulation system often present with soft tissue bleeding. If the results of the aPTT are
abnormal, mixing studies are usually carried out by the laboratory to access whether there is a deficiency or an
inhibitor of a clotting factor. In the most common type of hemophilia, hemophilia A (factor VIII deficiency), the
aPTT is prolonged but the PT and platelet count are normal.
The aPTT may be useful in evaluating patients who have a history of a condition known to be associated with the
risk of hemorrhage or thrombosis that is related to the intrinsic coagulation pathway. Such abnormalities may be
genetic or acquired. For example:

Dysfibrinogenemia

Afibrinogenemia (complete)

Acute or chronic liver dysfunction or failure, including Wilson’s disease

Hemophilia

Liver disease and failure

Infectious processes

Bleeding disorders

Disseminated intravascular coagulation

Lupus erythematosus or other conditions associated with circulating inhibitors, e.g., factor VIII
Inhibitor, lupus-like anticoagulant

Sepsis

Von Willebrand’s disease

Arterial and venous thrombosis, including the evaluation of hypercoagulable states
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
Clinical conditions associated with nephrosis or renal failure

Other acquired and congenital coagulopathies as well as thrombotic states
The aPTT is used along with the PT and other laboratory tests in the evaluation of patients with cancer
coagulopathy. The most common acquired coagulation factor deficiency in elderly oncology patients is factor VIII
deficiency. These patients can have widespread ecchymoses along with soft tissue bleeding. The aPTT is prolonged
and the PT is normal. Another reason for a prolonged aPTT in cancer patients is acquired von Willebrand disease,
which occurs in hematologic neoplasms and monoclonal gammopathies. These patients present with oozing from
surgical sites, nosebleeds, or gastrointestinal bleeding. Disseminated intravascular coagulation also occurs in
cancer patients. In severe cases, the PT and aPTT are prolonged and the platelet count is decreased.
Some factors that can affect the aPTT results include high hematocrit levels, high-fat meals before blood draw, and
heparin wash contamination in intravenous lines.
POLICY
For the following CPT code(s) in Table 1, the patient should have a diagnosis (ICD-9-CM, ICD-10-CM) code(s) listed in
the attached files below.
Table 1. HCPCS Codes (Alphanumeric, CPT AMA)
HCPCS Code
85730
Description
Thromboplastin time, partial (PTT); plasma or whole blood
ICD-10 Diagnosis Codes (Proven)
CMP-005 PTT ICD10
v2.2
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REFERENCES
1.
Kamal AH, Tefferi A, Pruthi RK. How to interpret and pursue an abnormal prothrombin time, activated partial
thromboplastin time and bleeding time in adults. Mayo Clin Proc. 2007;82(7):864-873.
2.
Hirsh J, Anand SS, Halperin JL, et al. AHA scientific statement: guide to anticoagulant therapy: heparin: a guide
for healthcare professionals from the American Heart Association. Arterioscler Thromb Vasc Biol.
2011;21(7):E9-9.
3.
Deloughery TG. Management of acquired bleeding problems in cancer patients. Emerg Med Clin North Am.
2009;(3):423-444.
4.
Centers for Medicare and Medicaid Services (CMS) Medicare National Coverage Determinations (NCD) Coding
Policy Manual and Change Report dated October 2011. Available at:
https://www.cms.gov/CoverageGenInfo/04_LabNCDs.asp#TopOfPage (Accessed: December 5, 2011).
5.
Hemostasis and Thrombosis: Basic Principles and Clinical Practice. Colman, et al editors, J.B. Lippincott, 3rd
Edition, 1994, pp 896-898and 1045-1046.
6.
College of American Pathologists Conference XXXI on Laboratory Monitoring of Anticoagulant Therapy. Arch
Pathol Lab Med. Vol 122, Sep 1998, P 782-798.
7.
Lupus Anticoagulants/Antiphospholipid-protein Antibodies: The Great Imposters, Triplett DA, Lupus.
1996:5:431.
POLICY HISTORY/REVISION HISTORY
Date
01/21/2017
12/03/2015
Action/Description
Updated ICD10 codes as per CMS recommendations. Removed ICD9 code file.
Annual Policy Review Completed – changes made:
Added ICD9 diagnosis codes related to malignant neoplasm:
141.0,144.0,150.9,151.9,152.9,153.5,153.9,154.0,154.1,154.3,157.0,157.1,157.8,161.9,162.3,16
2.9,170.3,170.4,171.9,172.2,172.8,172.9,173.90,174.1,174.2,174.4,174.8,183.0,185,188.9,189.0,
191.8,191.9,193,195.0,195.8,196.0,196.1,196.2,196.8,196.9,197.0,197.6,198.1,198.3,198.5,198.
7,198.89,200.78,201.91,202.74,202.88,202.96,205.00
10/01/2015
Added ICD10 diagnosis codes related to malignant neoplasm:
C01, C04.0, C15.9, C16.9, C17.9, C18.1, C18.9, C19, C20, C21.0, C25.0, C25.1, C25.7, C25.8, C32.9,
C34.10, C34.11, C34.12, C34.90, C34.91, C34.92, C40.00, C40.01, C40.02, C41.3, C43.20, C43.21,
C43.22, C43.8, C43.9, C44.90, C45.7, C47.9, C49.9, C50.111, C50.112, C50.119, C50.211,
C50.212, C50.219, C50.411, C50.412, C50.419, C50.811, C50.812, C50.819, C56.1, C56.2, C56.9,
C61, C64.1, C64.2, C64.9, C67.9, C71.8, C71.9, C73, C76.0, C76.8, C77.0, C77.1, C77.2, C77.8,
C77.9, C78.00, C78.01, C78.02, C78.6, C79.10, C79.11, C79.19, C79.31, C79.51, C79.52, C79.70,
C79.71, C79.72, C79.89, C79.9, C81.91, C82.58, C83.38, C84.44, C84.98, C84.A8, C84.Z8, C85.18,
C85.28, C85.88, C85.98, C92.00, C92.40, C92.50, C92.60, C92.A0, C96.9, C96.Z
Removed ICD9 table. Embedded ICD9/ ICD10 PDF files.
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