Summary & Overview
CPT 85230: Factor VII (Proconvertin) Clotting Assay
CPT code 85230 denotes a laboratory clotting test to detect the presence of factor VII (proconvertin) in patient serum. This specialized coagulation assay is clinically relevant for diagnosing inherited or acquired factor VII deficiency, evaluating unexplained bleeding, and guiding perioperative or anticoagulation management. Nationally, accurate coding for coagulation assays supports appropriate clinical interpretation, quality measurement, and laboratory reimbursement.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national overview of the clinical purpose of the test, typical sites of service, and common billing considerations. The content highlights what the code represents, where the service is delivered, and what to expect in terms of payer coverage patterns and claims processing considerations at a high level.
This publication provides clinical context for CPT code 85230, summarizes payer coverage presence, and outlines the primary operational aspects related to billing and service delivery. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 85230 describes a laboratory clotting assay performed to determine the presence of factor VII (also called proconvertin or stable factor) in a patient’s serum. The test evaluates the activity or presence of factor VII as part of coagulation assessment and can inform diagnosis of bleeding disorders or monitoring of coagulation function.
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Service type: Laboratory coagulation assay
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Typical site of service: Clinical laboratory or hospital laboratory setting
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45-year-old adult referred to the hospital clinical laboratory for evaluation of unexplained bleeding, prolonged prothrombin time, or preoperative coagulation assessment. The clinician suspects a deficiency or inhibitor of coagulation factor VII (proconvertin) after abnormal screening coagulation studies (prothrombin time prolonged with normal partial thromboplastin time). A phlebotomy is performed and serum/plasma is sent to the coagulation laboratory. The lab analyst performs a specific clotting assay to determine the presence and activity level of factor VII. Results guide hematology consultation, replacement therapy decisions (e.g., recombinant factor VII), or further testing for inherited versus acquired causes. Typical site of service is an outpatient clinical laboratory or hospital laboratory service within a hospital outpatient or inpatient setting, billed by the performing laboratory or facility.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional (interpretation) component provided by a physician or qualified professional. |
TC | Technical component | Use when reporting only the technical component (laboratory processing and testing) performed by the facility or performing laboratory. |