Hematology coding is not a piece of cake! The specialty has various procedures, some related to laboratory testing where a blood sample is drawn and examined, and some related to blood transfusion and bone marrow! If you are feeling lost among all these hematology CPT codes and need help, this guide is for you!
Our coding and billing experts have shortlisted the most commonly used CPT codes related to laboratory testing, bone marrow procedures, and transfusion and infusions to help you understand the descriptors and their relevant application via real-world scenarios.
So, without further ado, let’s get right into the details!
Most Common CPT Codes for Hematology
Discussed below are some of the most commonly used CPT codes for hematology, along with examples to help you understand each code application:
CPT Codes for Hematology Laboratory Tests
CPT Code 85002 – Bleeding Time Test
Hematology CPT code 85002 includes performing a bleeding time test to assess the body’s ability to form a clot and stop bleeding. It involves calculating the time for a prescribed incision to cease bleeding.
It is a critical hematology test that hematologists or other qualified healthcare professionals may request to evaluate a patient’s platelet function. This information aids in the timely diagnosis of conditions such as von Willebrand disease, platelet disorders, and certain medications that may affect platelet function.
Example:
Assume a patient visited the hematologist with a complaint about having easy bruising and prolonged bleeding after minor cuts. The healthcare provider suspected a potential platelet function disorder and requested a bleeding time test.
As a result, a phlebotomist made a prescribed incision on the patient’s forearm in the lab and carefully measured and recorded the time it took for the bleeding to stop entirely. Here, the 85002 CPT code for hematology will apply for accurate reimbursement.
CPT Code 85004 – Automated WBC Differential
It is one of the CPT codes for hematology that covers an automated differential white blood cell count. It involves utilizing specialized automated equipment to analyze a blood sample and determine all present white blood cell types. The insight enables the hematologist to diagnose various conditions, including hematological malignancies and inflammatory disorders.
Example:
A patient came to a clinician and complained about experiencing recurrent infections, fever, and fatigue. The healthcare provider, suspecting a potential blood disorder, requested a complete blood count with differential.
As a result, the patient’s blood sample was collected at the laboratory for analysis using an automated hematology analyzer. This machine automatically counted and differentiated the different types of blood cells, including basophils, eosinophils, monocytes, lymphocytes, and neutrophils. Thus, hematology CPT code 85004 will be reported to bill the procedure.
CPT Code 85025 – Automated CBC Differential
This CPT code for hematology is used to bill for complete blood count (CBC). This blood test offers detailed insight into various cell types in a blood sample.
A technician or a pathologist may draw blood from the patient’s vein using a syringe, store it in a test tube containing an anticoagulant, and send it to the laboratory. An automated analyzer is utilized to complete the cell-counting process.
Example:
Let’s consider a scenario where a patient encountered a healthcare provider with issues related to weakness, fatigue, and frequent infections. The physician orders a CBC with differential to investigate the root cause of the patient’s symptoms.
As a result, a technician draws the patient’s blood in a test tube and transports it to the lab, where it is analyzed using an automated hematology analyzer. The instrument accurately counted and differentiated the various blood cell types in the sample, including red blood cell count, hemoglobin level, white blood cell count, and number of platelets.
Since it precisely matches the hematology CPT code 85025 descriptor, it will be reported for fair payment against the performed procedure.
CPT Code 85610 – Prothrombin Time (PT) Test
This hematology CPT code is used to report the prothrombin time test. It is typically measured by adding chemicals like calcium and tissue factor to the blood plasma sample. The technician notes the time when the plasma clots. Besides, in cases where the physician wants to determine whether an anticoagulant drug or a blood thinner agent is working, the drug is mixed with the blood plasma sample, or the patient is advised to ingest the medicine before undergoing the test.
Example:
Let’s consider a scenario related to the 85610 CPT code for hematology! A patient is on Warfarin (an anticoagulant drug) due to a medical history of atrial fibrillation. Thus, the healthcare provider requested a PT test to evaluate the medication’s effectiveness and ensure the correct dosage.
As a result, a blood plasma sample is drawn from the patient and sent to the lab, where the blood is processed, and specific reagents are added to the plasma. The time the plasma takes to clot is then noted, and the findings are used to calculate the International Normalized Ratio (INR). It is a standardized measure that helps physicians determine the appropriate Warfarin dosage.
Hematology CPT Codes for Bone Marrow Procedures
CPT Code 38220 – Bone Marrow Biopsy and Aspiration
This code is for bone marrow aspiration and biopsy. It includes obtaining tissue samples from the patient’s bone marrow for diagnostic purposes. It helps the physician investigate various blood disorders, including lymphoma, leukemia, and anemia.
Example:
Consider a patient with unexplained weight loss, weakness, and fatigue visiting the doctor’s office. Blood test reports revealed abnormalities hinting towards blood disorders, such as leukemia or anemia. As a result, the hematologist recommended a bone marrow biopsy for further investigation.
The hematologist rendered a bone marrow biopsy and aspiration under sterile conditions after numbing the area by administering local anesthesia. A needle was inserted into the patient’s iliac crest (hip bone) to withdraw a small bone marrow tissue sample. This sample was sent to a pathology lab for microscopic examination.
Here, the 38220 CPT code for hematology will be reported.
CPT Code 38230 – Bone Marrow Harvest for Transplantation
38230 hematology CPT code covers the bone marrow harvest procedure from a healthy donor for transplantation into a recipient with a hematological malignancy or other conditions requiring a bone marrow transplant. Besides, it involves obtaining a large volume of bone marrow tissue, typically from the iliac crest (hip bone), for transplantation.
Example:
A healthy adult volunteered to be a bone marrow donor for a sibling diagnosed with leukemia. Therefore, the physician performed extensive testing to ensure the donor matched the recipient. After positive results, the donor underwent a bone marrow harvest procedure.
Under local anesthesia, the healthcare provider made a small incision in the pelvic bone of the donor via needles and extracted a sufficient volume of bone marrow for transplantation. This harvested bone marrow was processed and prepared for transplantation into the recipient.
38230 CPT code for hematology applies here for fair reimbursement.
Hematology CPT Codes for Transfusions and Infusions
CPT Code 36430 – Venipuncture and Blood Transfusion
It describes the venipuncture procedure and the administration of blood or blood components transfusion. This hematology CPT code covers establishing intravenous access, checking the compatibility of the blood product, and carefully infusing the blood component into the patient’s bloodstream.
Example:
Assume a patient with severe anemia due to chronic blood loss needs a blood transfusion. For the unversed, it is a condition in which a person loses blood gradually over time. Thus, the nurse prepares the patient for venipuncture by selecting an appropriate vein to establish intravenous access.
A unit of packed red blood cells is administered slowly via the intravenous line after carefully examining it for compatibility. Besides, throughout the transfusion procedure, the nurse monitors the patient closely for any signs of adverse reactions, including breathing issues, fever, chills, etc.
CPT Code 36470 – Sclerotherapy for Single Vein
This hematology CPT code covers the sclerotherapy procedure to treat a single incompetent vein. It is a minimally invasive procedure involving a sclerosing solution in the affected vein to irritate the lining. This solution inflames the lining, which eventually forms a scar and collapses. The healthcare provider may recommend this care service to treat a varicose vein and other vascular malformation types.
Example:
Here’s a scenario for better understanding! A patient visited the physician with unsightly and uncomfortable varicose veins on their lower legs. After thoroughly examining, the clinician suggested sclerotherapy.
The healthcare provider administered a sclerosing solution using a fine needle directly into the affected vein to irritate the lining, making it collapse and disappear eventually. Thus, the 36470 CPT code for hematology will be reported here for accurate reimbursement.
Conclusion
In this guide, we have discussed some of the most commonly used CPT codes for hematology. These included CPT codes related to laboratory tests, such as 85002 (bleeding time test), 85004 (automated WBC differential), 85025 (automated CBC differential), and 85610 (prothrombin time test). Besides, we explained CPT codes related to bone marrow procedures, including 38220 (bone marrow biopsy and aspiration) and 38230 (bone marrow harvest for transplantation). A couple of codes related to transfusions and infusions were also covered, including 36430 (venipuncture and blood transfusion) and 36470 (sclerotherapy for single veins).We hope that this guide will clarify how to handle billing and coding in your hematology practice. However, if you still have trouble, why not outsource hematology billing services to professionals like MediBillMD? We house an experienced team of certified professional coders (CPCs) and billing specialists who are ready to offload your administrative burden and streamline the revenue cycle for a steady cash flow.
