How To Use CPT Code 85018

CPT 85018 is a code used for measuring hemoglobin levels in blood samples, and this article will cover its description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT 85018?

CPT 85018 is a medical billing code used to describe the procedure of measuring hemoglobin levels in a whole blood sample. Hemoglobin is a red pigmented iron compound found in red blood cells that combines with oxygen needed by body tissues. This code is used by medical professionals to bill for the laboratory analysis of hemoglobin levels in blood samples.

2. 85018 CPT code description

The official description of CPT code 85018 is: “Blood count; hemoglobin (Hgb)”

3. Procedure

The procedure for CPT 85018 involves the following steps:

1. Collection of a whole blood sample from the patient, typically through venipuncture.
2. Preparation of the blood sample for analysis, which may include centrifugation or other processing methods.
3. Measurement of hemoglobin levels in the blood sample using an automated cell counter or manual testing kits. This is typically done through a spectrophotometric technique that measures the amount of light absorbed by the sample after a chemical reaction, which then calculates the hemoglobin levels.
4. Documentation of the hemoglobin levels in grams per deciliter (g/dL) and reporting the results to the ordering clinician.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 85018 services include those who require hemoglobin level testing for various reasons, such as:

• Monitoring anemia or other blood disorders
• Evaluating the effectiveness of blood transfusions
• Screening blood donors before blood collection
• Assessing overall health as part of a routine checkup

5. When to use CPT code 85018

It is appropriate to bill the 85018 CPT code when a clinician orders a hemoglobin test as a standalone procedure, without the need for a complete blood count or other blood tests. This may occur when the primary interest is to check the red cell mass or concentration in the blood, or when retesting a patient after a blood transfusion to ensure their hemoglobin levels have improved.

6. Documentation requirements

To support a claim for CPT 85018, the following information should be documented:

• Medical necessity for the hemoglobin test, including the patient’s diagnosis or symptoms that warrant the test
• Order from the clinician for the hemoglobin test
• Method used for measuring hemoglobin levels (e.g., automated cell counter or manual testing kit)
• Results of the hemoglobin test, including the measured levels in grams per deciliter (g/dL)
• Date and time of the test
• Identification of the laboratory performing the test

7. Billing guidelines

When billing for CPT code 85018, it is important to follow the appropriate guidelines and rules to ensure accurate reimbursement. Some tips for billing this code include:

• Ensure that the documentation supports the medical necessity for the hemoglobin test
• Verify that the test was ordered by a qualified healthcare professional
• Include any relevant modifiers, such as -59 for a distinct procedural service, if applicable
• Be aware that some payers may require the use of additional codes, such as 36415 for the collection of venous blood by venipuncture

8. Historical information

CPT 85018 was added to the Current Procedural Terminology system on January 1, 1990. The code description was changed on January 1, 2003, from “Blood count; hemoglobin” to “Blood count; hemoglobin (Hgb)”.

9. Similar codes to CPT 85018

There are several codes related to CPT 85018 that differentiate in various ways:

• CPT 85014: This code is used for measuring hematocrit levels, which is another parameter related to red blood cell concentration.
• CPT 88738: This code is for transcutaneous hemoglobin measurement, which is a non-invasive method of measuring hemoglobin levels.
• CPT 83020 – 83069: These codes are used for other types of hemoglobin determination, such as electrophoresis or chromatography.
• CPT 82274: This code is for immunoassay hemoglobin testing in fecal samples, which is used to detect gastrointestinal bleeding.
• CPT 85025 or 85027: These codes are for complete blood count tests, which include hemoglobin measurement along with other blood parameters.

10. Examples

Here are 10 detailed examples of CPT code 85018 procedures:

1. A patient with a history of anemia requires a hemoglobin test to monitor their condition and adjust treatment as needed.
2. A patient who recently received a blood transfusion needs a hemoglobin test to ensure their levels have improved.
3. A blood donor is screened for adequate hemoglobin levels before donating blood to ensure their safety and the quality of the donated blood.
4. A patient with unexplained fatigue undergoes a hemoglobin test to rule out anemia as a potential cause.
5. A pregnant woman has a hemoglobin test as part of routine prenatal care to monitor for pregnancy-related anemia.
6. A patient with chronic kidney disease requires a hemoglobin test to assess their risk for anemia related to their condition.
7. A patient undergoing chemotherapy has a hemoglobin test to monitor for potential treatment-related anemia.
8. A patient with a gastrointestinal bleed has a hemoglobin test to assess the severity of blood loss and guide treatment decisions.
9. A patient with a suspected hemoglobinopathy, such as sickle cell disease, undergoes a hemoglobin test as part of their diagnostic workup.
10. A patient with iron deficiency anemia has a hemoglobin test to evaluate the effectiveness of iron supplementation therapy.