CPT® Code 85230

Official Description

Clotting; factor VII (proconvertin, stable factor)

Common Language Description

The CPT® Code 85230 refers to a laboratory test specifically designed to measure the activity of factor VII, also known as proconvertin or stable factor. Factor VII is classified as a vitamin K-dependent protein enzyme that plays a crucial role in the coagulation process. It is categorized within the serine protease class of enzymes and is essential for initiating coagulation in conjunction with Factor III, commonly referred to as tissue factor. A deficiency in Factor VII, although rare, can lead to a bleeding disorder that resembles hemophilia. This deficiency can be inherited genetically or acquired due to various conditions such as vitamin K deficiency, bile duct obstruction, liver disease, or as a result of anticoagulant therapy. Patients with Factor VII deficiency may exhibit symptoms such as easy bruising, frequent nosebleeds, soft tissue or joint hemorrhages, and excessive bleeding during surgical procedures or menstruation. The factor VII activity test is typically ordered when a patient presents with abnormal bleeding times, as indicated by prothrombin time (PT) or activated partial thromboplastin time (PTT) tests, or when there is a family history of coagulation factor deficiencies. Additionally, this test may be utilized to monitor the severity of the factor defect and the effectiveness of any ongoing treatment. To perform this test, a blood sample is collected through a venipuncture, which is a separately reportable procedure. The analysis is conducted on platelet-poor plasma using a prothrombin clot-based assay, ensuring accurate measurement of factor VII activity.

1. Indications

The test for factor VII activity (CPT® Code 85230) is indicated in several clinical scenarios, particularly when there are concerns regarding bleeding disorders or coagulation factor deficiencies. The following are the specific indications for performing this test:

Abnormal Bleeding Time Tests The factor VII activity test may be ordered when a patient exhibits abnormal results in bleeding time tests, such as prothrombin time (PT) or activated partial thromboplastin time (PTT), which can indicate potential coagulation issues.
Family History of Coagulation Factor Deficiencies Patients with a family history of coagulation factor deficiencies may require this test to assess their own risk and to determine if they have inherited a deficiency in factor VII.
Monitoring Treatment Effectiveness The test is also utilized to monitor the severity of a factor VII defect and to evaluate the effectiveness of any ongoing treatment for patients diagnosed with factor VII deficiency.

2. Procedure

The procedure for testing factor VII activity involves several key steps that ensure accurate measurement of the factor's activity in the blood. The following outlines the procedural steps involved:

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 instructions should be provided by the healthcare provider.
Step 2: Blood Sample Collection 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 draw blood. This step is crucial as the sample must be collected in a manner that prevents contamination and ensures the integrity of the plasma for testing.
Step 3: Plasma Preparation After collection, the blood sample is processed to obtain platelet-poor plasma. This is done by centrifuging the blood to separate the plasma from the cellular components, ensuring that the test measures only the factor VII activity in the plasma.
Step 4: Testing Procedure The prepared platelet-poor plasma is then subjected to a prothrombin clot-based assay. This assay measures the activity of factor VII by evaluating the time it takes for a clot to form in the presence of tissue factor, providing a quantitative assessment of factor VII activity.

3. Post-Procedure

After the factor VII activity test is completed, there are generally no specific post-procedure care requirements for the patient. However, it is important for the healthcare provider to monitor the patient for any potential complications related to the venipuncture, such as bruising or discomfort at the site of blood draw. The results of the test will be analyzed and reported, and the healthcare provider will discuss the findings with the patient, including any necessary follow-up actions based on the results. If factor VII deficiency is confirmed, further evaluation and treatment options may be considered to manage the condition effectively.

Short Descr	CLOT FACTOR VII PROCONVERTIN
Medium Descr	CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR
Long Descr	Clotting; factor VII (proconvertin, stable 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.
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
GA	Waiver of liability statement issued as required by payer policy, individual case
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.
GW	Service not related to the hospice patient's terminal condition
Q4	Service for ordering/referring physician qualifies as a service exemption