A CPT overhaul for hematology
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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
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
- 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.”
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
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
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.
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.