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A CPT overhaul for hematology

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Correction

December 2002

The CPT 2003 hematology section (85002–85048 and 85585–85595) has been updated to reflect current laboratory practice. Although attempts to contemporize specific codes in the hematology section have been made in past years, there hasn’t been a comprehensive update in more than two decades. This long overdue update at the request of American Medical Association staff represents the collaborative effort of many in the laboratory community, including the CAP.

To better organize and modernize the codes in the hematology section, some of the code descriptors were revised, new codes were added, and some codes were deleted. The following changes were made to assist the laboratory community.

Peripheral blood smears
In hematology laboratory practice, manual microscopic review of peripheral blood smears by laboratory technologists is placed in three basic categories:

• Traditional manual leukocyte (WBC) differential.
• Review of a peripheral smear without a leukocyte differential because the automated complete blood count data suggest potentially significant abnormalities.
• Buffy coat preparation because the leukocyte count is insufficient to allow adequate examination by the traditional differential.

Therefore, codes 85007, 85008, and 85009 were revised in CPT 2003 to reflect this current practice. In addition, new code 85004 was added for blood counts with automated WBC count and is now the “parent” code for the blood count family of codes.

Hemoglobin and hematocrit
An editorial change was made to code 85014 to add the word “hematocrit” next to the abbreviation “Hct.” Continue to use the code to report hematocrit, other than spun hematocrit. Similarly, code 85018 was changed to add the abbreviation for hemoglobin (Hgb) to the code descriptor, “Blood count; hemoglobin.”

Automated hematology
In contemporary practice, partial and complete automated WBC differential counts no longer are sufficiently different in work or cost to warrant separation. In addition, because it is rare in current clinical practice to require the WBC and RBC without the context of the platelet count, current automated CBC instruments include a platelet count. Therefore, codes 85021–85024 were deleted.

The revised code 85027 serves as the base code for laboratories that perform the appropriate WBC differential depending on the results of the automated CBC. To code 85027 the laboratory should add the appropriate WBC differential code (85007, 85008, or 85009).

Laboratories, such as large reference laboratories, that routinely perform automated differentials should report the revised 85025 code for automated complete CBC with automated differential WBC count. Automated complete CBC is defined as hemoglobin, hematocrit, RBC, and WBC.

Individual parameter codes using automated instrumentation
Use the revised 85041 code to report automated red blood cell counts only. Do not report this code in conjunction with codes 85025 or 85027.

Use the revised 85045 code to report all automated reticulocyte counts.

An editorial change was made to code 85048 to use the terminology “leukocyte” instead of “white blood cell.” Continue to use code 85048 for automated leukocyte counts.

Platelet count code 85595 was moved from the coagulation section and replaced with new code 85049. Editorial revisions were made to the new code so that it fits into the blood count family better; however, it should still be used to report automated platelet counts.

Manual routine hematology
In contemporary practice the complete manual CBC is extremely rare; therefore, code 85031 was deleted. If a complete manual CBC is necessary, use codes 85014 and 85018 and three units of 85036. A complete manual CBC is defined as RBC, WBC, hemoglobin, hematocrit, differential, and indices. If individual parts of the evaluation are necessary, use one unit of 85036 for each manual erythrocyte, leukocyte, or platelet count.

Correction

Manual platelet count code 85590 was moved from the coagulation section and replaced with new code 85036. Editorial revisions were made to the new code so that it fits into the blood count family better. However, it should still be used to report manual platelet counts.

The word “count” was removed from code 85044. Continue to use it for manual reticulocyte counts.

Leslie Narramore