medicare medical necessity icd 10 code for factor ii leiden mutation

by Corine Hermann 6 min read

Full Answer

What is the latest ICD 10 version for Leiden mutation?

The 2021 edition of ICD-10-CM D68.51 became effective on October 1, 2020. This is the American ICD-10-CM version of D68.51 - other international versions of ICD-10 D68.51 may differ. Applicable To. Factor V Leiden mutation.

What is factor V Leiden mutation?

In the human body, factor V is a protein that is necessary for proper blood clotting. Some people have a genetic mutation of the protein which is called factor V Leiden. This is a disorder that can cause a condition known as thrombophilia. If you have the factor V Leiden mutation, you are at greater risk of developing blood clots.

Does Medicare cover factor V Leiden testing?

If you or your health care provider suspect that you may be at a higher risk for factor V Leiden, you may need more information about whether your Medicare benefits cover testing. If you have a mutation in your F5 gene, this causes factor V Leiden thrombophilia.

What is the ICD 10 code for methylenetetrahydrofolate reductase mutation?

Methylenetetrahydrofolate reductase mutation. ICD-10-CM E72.12 is grouped within Diagnostic Related Group (s) (MS-DRG v38.0): 642 Inborn and other disorders of metabolism. Convert E72.12 to ICD-9-CM.

What is the ICD 10 code for factor V Leiden mutation?

Factor v leiden mutation (r506q) is the most common cause of apc resistance. An abnormality that refers to mutation of factor v leiden, which is a variant of human factor v. It results in thrombophilia, deep vein thrombosis, and a slightly increased risk of miscarriage.

Is Factor V Leiden covered by Medicare?

This testing is considered investigational and is NOT a Medicare benefit.

What diagnosis code will cover Factor V Leiden?

Group 1CodeDescription81241F5 (COAGULATION FACTOR V) (EG, HEREDITARY HYPERCOAGULABILITY) GENE ANALYSIS, LEIDEN VARIANT81291MTHFR (5,10-METHYLENETETRAHYDROFOLATE REDUCTASE) (EG, HEREDITARY HYPERCOAGULABILITY) GENE ANALYSIS, COMMON VARIANTS (EG, 677T, 1298C)1 more row

What is the ICD 10 code for Factor 5?

Hereditary deficiency of other clotting factors The 2022 edition of ICD-10-CM D68. 2 became effective on October 1, 2021. This is the American ICD-10-CM version of D68.

Is Factor V Leiden test covered by insurance?

Part A (hospital insurance) covers the cost of your Factor V Leiden screening test if your physician deems it medically necessary and orders it while you are being cared for as an inpatient or in a skilled nursing facility.

What is the ICD 10 code for family history of factor V Leiden?

Z83. 2 - Family history of diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism | ICD-10-CM.

What is factor V Leiden mutation analysis?

Factor V Leiden (FVL) mutation and prothrombin 20210 (PT 20210) mutation tests are two tests often used together to help diagnose the cause of inappropriate blood clot (thrombus) formation, including deep vein thrombosis (DVT) and/or venous thromboembolism (VTE).

What is factor V Leiden heterozygous?

Heterozygous means that the 2 copies of a gene are different. In your case, one of your Factor V gene codes is for normal clotting Factor V and the other Factor V gene code is for Factor V Leiden. There is more risk of a blood clot if both gene codes are for Factor V Leiden (ie in the homozygous state).

What diagnosis covers CPT 85610?

A: When physicians use a prothrombin time test (reported with CPT code 85610) to monitor patients on anticoagulant drugs, Medicare pays the entity that performed the test. Its payment for the test is based on the geographically specific laboratory test fee schedule.

What ICD-10 covers PT PTT?

NCD - Partial ThromboplastinTime (PTT) (190.16)

What is the ICD-10 code for PE?

ICD-10 code I26. 9 for Pulmonary embolism without acute cor pulmonale is a medical classification as listed by WHO under the range - Diseases of the circulatory system .

What is Parahemophilia?

Factor V deficiency is also known as Owren's disease or parahemophilia. It's a rare bleeding disorder that results in poor clotting after an injury or surgery. Factor V deficiency shouldn't be confused with factor V Leiden mutation, a much more common condition that causes excessive blood clotting.

Document Information

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

Title XVIII of the Social Security Act (SSA), §1862 (a) (1) (A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Coverage Guidance

This is a non-coverage policy for genetic testing for thrombophilia testing for the Factor V Leiden (FVL) variant in F5 gene, the 20210G> (G20210A) variant in the F2 gene, and the MTHFR gene which encodes the 5, 10-methylenetetrahydrofolate reductase enzyme.

What insurance covers factor V?

Part A (hospital insurance) covers the cost of your Factor V Leiden screening test if your physician deems it medically necessary and orders it while you are being cared for as an inpatient or in a skilled nursing facility.

How to find out if you have factor V?

In order to find out if you have factor V Leiden, a screening can be done by taking a sample of your blood to test for activated protein C resistance. A positive result may mean that you have the factor V Leiden mutation.

Why should you be tested for factor V?

Because deep vein thrombosis and pulmonary embolism are serious enough to be life threatening, if you suspect that you have the genetic mutation of factor V, factor V Leiden, you should be tested to determine your risk factor for thrombophilia.

What is factor V?

In the human body, factor V is a protein that is necessary for proper blood clotting. Some people have a genetic mutation of the protein which is called factor V Leiden. This is a disorder that can cause a condition known as thrombophilia. If you have the factor V Leiden mutation, you are at greater risk of developing blood clots.

Where does factor V clotting occur?

This abnormal clotting most commonly occurs in either the deep veins of the legs (deep vein thrombosis), or in the lungs (pulmonary embolism). Not everyone who has factor V Leiden experiences abnormal clotting, but there is a higher risk for those that do.

Is factor V inherited?

Statistics indicate that factor V Leiden is the most common inherited form of thrombophilia in the United States and Europe among Caucasians. Fortunately, Medicare recipients have coverage for the necessary blood test needed to screen for this condition.

Is factor V Leiden hereditary?

Because factor V Leiden is a hereditary condition, you may have an increased chance of having it if you have a relative with factor V Leiden. It is also more common for Caucasians of European descent to have this factor V mutation. In order to find out if you have factor V Leiden, a screening can be done by taking a sample ...

General Information

CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

Title XVIII of the Social Security Act §1833 (e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Article Guidance

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Homocysteine Level, Serum L34419.

ICD-10-CM Codes that Support Medical Necessity

The correct use of an ICD-10 code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the Homocysteine Level, Serum L34419 LCD.

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.

Description Information

Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Coding Analyses for Labs (CALs)

This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with CALs, from the Coding Analyses for Labs database.