CPT® Code 85220

Official Description

Clotting; factor V (AcG or proaccelerin), labile factor

Common Language Description

The CPT® Code 85220 refers to a laboratory test specifically designed to measure the activity of factor V, also known as AcG or proaccelerin, which is classified as a labile factor in the coagulation cascade. Factor V is a crucial vitamin K-dependent protein synthesized primarily in the liver, as well as in the endothelium, megakaryocytes, and platelets. Although factor V itself is not an active enzyme, it plays a vital role as a co-factor that is activated by thrombin during the coagulation process. A deficiency in factor V can lead to a rare genetic disorder known as inherited Factor V deficiency, which manifests as a mild form of hemophilia, specifically referred to as Owren hemophilia. This deficiency can also be acquired due to various conditions such as liver disease, autoimmune disorders, certain cancers, myeloproliferative diseases, disseminated intravascular coagulation (DIC), secondary fibrinolysis, and the effects of certain medications. Patients with Factor V deficiency may experience symptoms such as easy bruising, frequent nosebleeds, soft tissue hemorrhages, and excessive bleeding during surgical procedures or menstruation. Conversely, elevated levels of Factor V, particularly the Leiden variant, are associated with a genetic mutation that results in hypercoagulability, increasing the risk of venous thrombosis. The factor V activity test is typically ordered when patients present with abnormal bleeding times, as indicated by prothrombin time (PT) and activated partial thromboplastin time (PTT) tests, or when there is a family history of coagulation factor deficiencies. Additionally, this test may be utilized to assess the severity of the factor defect and to monitor the effectiveness of treatment interventions. The test is performed on a blood sample, which is obtained through a separately reportable venipuncture, and involves testing platelet-poor plasma using a prothrombin clot-based assay.

1. Indications

The factor V activity test (CPT® Code 85220) is indicated for several clinical scenarios, particularly when there are concerns regarding bleeding disorders or coagulation abnormalities. The following conditions may warrant the performance of this test:

Abnormal Bleeding Time Tests - The test may be ordered when patients exhibit abnormal results in prothrombin time (PT) or activated partial thromboplastin time (PTT), which can indicate potential coagulation issues.
Family History of Coagulation Factor Deficiencies - Individuals with a family history of coagulation disorders may be tested to determine if they have inherited deficiencies, including Factor V deficiency.
Monitoring Treatment Effectiveness - The test can be utilized to monitor the severity of a known factor V defect and to evaluate the effectiveness of ongoing treatment for coagulation disorders.
Symptoms of Factor V Deficiency - Patients presenting with symptoms such as easy bruising, frequent nosebleeds, soft tissue hemorrhages, or excessive bleeding during surgical procedures or menstruation may require this test to assess factor V activity.

2. Procedure

The procedure for conducting the factor V activity test involves several key steps to ensure accurate measurement of factor V levels in the blood. The following procedural steps are outlined:

Step 1: Patient Preparation - Prior to the test, the patient may be instructed to avoid certain medications or supplements that could affect coagulation, although specific guidelines should be followed as per the laboratory's protocols.
Step 2: Venipuncture - A blood sample is obtained through a venipuncture, which is a procedure where a needle is inserted into a vein, typically in the arm, to collect blood. This step is crucial as the sample must be handled properly to ensure the integrity of the test results.
Step 3: Plasma Preparation - After collection, the blood sample is processed to obtain platelet-poor plasma. This is achieved by centrifuging the blood to separate the plasma from the cellular components, ensuring that the test measures only the factor V activity in the plasma.
Step 4: Testing - The prepared platelet-poor plasma is then subjected to a prothrombin clot-based assay. This assay measures the activity of factor V by evaluating its role in the coagulation cascade, specifically how it interacts with thrombin to facilitate clot formation.
Step 5: Result Interpretation - Once the assay is complete, the results are analyzed and interpreted by laboratory personnel. The findings will indicate the level of factor V activity, which can help in diagnosing deficiencies or excesses in coagulation factors.

3. Post-Procedure

After the factor V activity test is completed, there are generally no specific post-procedure care requirements for the patient. However, it is advisable for patients to monitor the venipuncture site for any signs of excessive bleeding or bruising. If any unusual symptoms occur, such as prolonged bleeding or significant discomfort, patients should contact their healthcare provider. The results of the test will typically be communicated to the ordering physician, who will discuss the findings with the patient and determine any necessary follow-up actions or treatments based on the results.

Short Descr	BLOOC CLOT FACTOR V TEST
Medium Descr	CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR
Long Descr	Clotting; factor V (AcG or proaccelerin), labile factor
Status Code	Statutory Exclusion (from MPFS, may be paid under other methodologies)
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
CLIA Waived (QW)	No
APC Status Indicator	Conditionally packaged laboratory tests
Type of Service (TOS)	5 - Diagnostic Laboratory
Berenson-Eggers TOS (BETOS)	T1H - Lab tests - other (non-Medicare fee schedule)
MUE	2
CCS Clinical Classification	233 - Laboratory - Chemistry and Hematology

90	Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number.
26	Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.
91	Repeat clinical diagnostic laboratory test: in the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. note: this modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. this modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). this modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient.
GA	Waiver of liability statement issued as required by payer policy, individual case
GW	Service not related to the hospice patient's terminal condition
GY	Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit