CPT® Code 85270

Official Description

Clotting; factor XI (PTA)

Common Language Description

The CPT® Code 85270 refers to a laboratory test that measures the activity of clotting factor XI, which is also known as plasma thromboplastin antecedent (PTA). This test is crucial for diagnosing conditions related to clotting deficiencies, particularly hemophilia C and Rosenthal syndrome, both of which are associated with a deficiency in factor XI. Factor XI plays a significant role in the coagulation cascade, functioning as a zymogen that is activated by factor XIIa or thrombin. Once activated, it acts as a trypsin-like serine protease, facilitating the activation of other clotting factors and enzymes necessary for proper blood coagulation. Factor XI exists in two forms within the body: platelet factor XI, which is produced by megakaryocytes, and plasma factor XI, synthesized in the liver. A deficiency in factor XI is primarily inherited and affects both males and females equally. However, it can also occur, albeit rarely, in patients with lupus erythematosus. The clinical manifestations of factor XI deficiency can vary significantly among individuals and do not always correlate with the measurable levels of factor XI in the blood. Some patients may experience immediate or delayed bleeding episodes, while others may report heavy menstrual bleeding, particularly among women. Interestingly, many individuals with factor XI deficiency may not exhibit any bleeding symptoms at all, and the condition is often identified through abnormal laboratory tests, such as an activated partial thromboplastin time (aPTT) test. The test for factor XI deficiency involves obtaining a blood sample through venipuncture, and the analysis is performed on platelet-poor plasma using an activated partial thromboplastin clot-based assay.

1. Indications

The CPT® Code 85270 is indicated for use in the following scenarios:

Diagnosis of Factor XI Deficiency This test is performed to confirm the presence of factor XI deficiency, which can lead to bleeding disorders such as hemophilia C and Rosenthal syndrome.
Investigation of Abnormal aPTT The test is utilized to investigate the underlying causes of an abnormal activated partial thromboplastin time (aPTT) result, which may indicate a clotting disorder.
Assessment of Bleeding Symptoms It is indicated for patients presenting with unexplained bleeding symptoms, including heavy menstrual bleeding, to determine if factor XI deficiency is a contributing factor.

2. Procedure

The procedure for conducting the test associated with CPT® Code 85270 involves several key steps:

Step 1: Patient Preparation Prior to the test, the patient may be instructed to avoid certain medications or supplements that could affect clotting factors. It is essential to ensure that the patient is adequately informed about the procedure and any necessary preparations.
Step 2: Venipuncture A blood sample is obtained through a venipuncture, which is a standard procedure where a needle is inserted into a vein, typically in the arm, to collect blood. This step is crucial as the quality of the sample can impact the test results.
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 plasma used for testing does not contain platelets that could interfere with the assay.
Step 4: Testing The platelet-poor plasma is then subjected to an activated partial thromboplastin clot-based assay. This assay measures the activity of factor XI and helps determine if there is a deficiency present.

3. Post-Procedure

After the procedure, the patient may be advised to resume normal activities unless otherwise directed by their healthcare provider. The results of the factor XI activity test will be analyzed and reported, typically within a few days. If a deficiency is detected, further evaluation and management may be necessary, which could include genetic counseling or additional testing to assess the severity of the condition. It is important for healthcare providers to discuss the results with the patient and outline any necessary follow-up actions or treatments based on the findings.

Short Descr	CLOT FACTOR XI PTA
Medium Descr	CLOTTING FACTOR XI PTA
Long Descr	Clotting; factor XI (PTA)
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.
Q4	Service for ordering/referring physician qualifies as a service exemption