© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 85250 refers to a laboratory test specifically designed to measure the activity of clotting factor IX, also known as PTC or Christmas factor. This factor is a vitamin K-dependent protein that plays a crucial role in the blood coagulation process. In its inactive form, factor IX circulates in the plasma as a zymogen, which is then activated to a serine protease during the clotting cascade. A deficiency in factor IX is typically associated with an inherited genetic condition known as Hemophilia B, or Christmas disease, which predominantly affects males due to its X-linked genetic mutation. The severity of Hemophilia B can vary significantly among individuals, with approximately 60% of cases exhibiting severe deficiency (less than 1% of normal factor IX levels), 15% showing moderate deficiency (1-5% of normal levels), and 25% presenting with mild deficiency (6-30% of normal levels). Individuals with severe factor IX deficiency are at a heightened risk for spontaneous bleeding, while those with moderate deficiency may experience bleeding from mild to moderate injuries and occasionally spontaneous bleeding in joints and soft tissues. Additionally, there are rare genetic mutations that can lead to elevated levels of factor IX, which may increase the risk of hypercoagulation and thrombus formation. The test for factor IX activity is essential for diagnosing factor IX deficiency, monitoring replacement therapy, investigating abnormal bleeding times (such as prothrombin time (PT) and activated partial thromboplastin time (PTT)), and assessing the effects of liver disease on hemostasis. To perform this test, a blood sample is collected, typically through a venipuncture, and the platelet-poor plasma is analyzed using an activated partial thromboplastin clot-based immunoassay.
© Copyright 2025 Coding Ahead. All rights reserved.
The CPT® Code 85250 is indicated for use in various clinical scenarios related to clotting factor IX activity. The following conditions and situations warrant the performance of this test:
The procedure for performing the test associated with CPT® Code 85250 involves several key steps that ensure accurate measurement of factor IX activity:
After the procedure, the patient may experience minimal discomfort at the venipuncture site, which typically resolves quickly. The results of the factor IX activity test will be analyzed and reported, providing critical information for the diagnosis and management of clotting disorders. It is important for healthcare providers to interpret the results in conjunction with clinical findings and other laboratory tests to ensure comprehensive patient care. Follow-up may be necessary to discuss the results and any further actions required based on the findings.
| Short Descr | CLOT FACTOR IX PTC/CHRSTMAS | Medium Descr | CLOTTING FACTOR IX PTC/CHRISTMAS | Long Descr | Clotting; factor IX (PTC or Christmas) | 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. | 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. | 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. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | GA | Waiver of liability statement issued as required by payer policy, individual case | Q4 | Service for ordering/referring physician qualifies as a service exemption |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2013-01-01 | Changed | Short Descriptor changed. |
| Pre-1990 | Added | Code added. |
Get instant expert-level medical coding assistance.