How To Use CPT Code 85652

CPT 85652 is an automated erythrocyte sedimentation rate (ESR) test used to measure inflammation in the body. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 85652 procedures.

1. What is CPT 85652?

CPT 85652 is a code used for an automated erythrocyte sedimentation rate (ESR) test. This test measures the rate at which red blood cells (erythrocytes) settle in a blood sample over a specific period. The results of this test can provide valuable information about the presence of inflammation in the body, which may be caused by various conditions such as infection, cancer, or autoimmune diseases. The test is performed using an automated platform, which provides more accurate and consistent results compared to manual ESR testing.

2. 85652 CPT code description

The official description of CPT code 85652 is: “Sedimentation rate, erythrocyte; automated.”

3. Procedure

1. A blood sample is collected from the patient, typically through venipuncture.
2. The blood sample is placed in an automated ESR testing platform.
3. The platform uses a vacuum pump to aspirate a specific volume of blood into a Westergren pipette and dilutes it with a solution such as sodium citrate.
4. The test instrument measures sedimentation at a specific time, such as 30 minutes, using an optical density measure at a specific wavelength.
5. An algorithm is used to report the results in mm/hour based on a correlation curve.

4. Qualifying circumstances

Patients who are experiencing symptoms or have a medical history that suggests the presence of inflammation may be eligible to receive CPT code 85652 services. This may include individuals with suspected or confirmed infections, cancer, or autoimmune diseases. Additionally, the test may be used to monitor response to therapy for certain conditions, such as systemic lupus erythematosus (SLE).

5. When to use CPT code 85652

It is appropriate to bill the 85652 CPT code when an automated ESR test is performed to evaluate the presence of inflammation in the body. This may be ordered by a clinician as part of a diagnostic workup for various conditions or to monitor the response to therapy for certain diseases.

6. Documentation requirements

To support a claim for CPT 85652, the following information should be documented:

• Patient’s medical history and symptoms that indicate the need for an ESR test.
• Clinician’s order for the automated ESR test.
• Details of the blood sample collection, including the date and time of collection.
• Results of the automated ESR test, including the sedimentation rate in mm/hour.
• Interpretation of the test results by the clinician and any subsequent treatment plan or recommendations.

7. Billing guidelines

When billing for CPT code 85652, it is important to follow the specific guidelines and rules set forth by the payer. Some payers may pay separately for the collection of the blood specimen using a code such as 36415 for venipuncture. Additionally, it is crucial to distinguish CPT 85652 for automated ESR from 85651 for manual ESR testing, as the two codes represent different procedures and may have different reimbursement rates.

8. Historical information

CPT 85652 was added to the Current Procedural Terminology system on January 1, 1996. There have been no updates to the code since its addition.

9. Similar codes to CPT 85652

Five similar codes to CPT 85652 and how they differentiate from CPT 85652 are:

1. CPT 85651: This code is used for manual erythrocyte sedimentation rate testing, which is a different procedure than the automated test represented by CPT 85652.
2. CPT 85025: This code is used for a complete blood count (CBC) with automated differential white blood cell (WBC) count, which is a more comprehensive blood test that includes multiple components, not just sedimentation rate.
3. CPT 85027: This code is used for a complete blood count (CBC) without differential WBC count, which is another comprehensive blood test that does not focus solely on sedimentation rate.
4. CPT 85610: This code is used for prothrombin time (PT) testing, which measures the time it takes for blood to clot and is not related to sedimentation rate.
5. CPT 85730: This code is used for activated partial thromboplastin time (aPTT) testing, which is another blood clotting test that does not measure sedimentation rate.

10. Examples

Here are 10 detailed examples of CPT code 85652 procedures:

1. A patient with suspected rheumatoid arthritis undergoes an automated ESR test to assess the level of inflammation in their body.
2. A patient with a history of cancer has an automated ESR test performed to monitor for potential recurrence or metastasis.
3. An individual with a suspected infection has an automated ESR test ordered by their clinician to help determine the severity of the infection.
4. A patient with systemic lupus erythematosus (SLE) undergoes an automated ESR test to monitor their response to treatment.
5. An individual with unexplained fatigue and joint pain has an automated ESR test performed to evaluate for possible autoimmune disease.
6. A patient with a history of vasculitis has an automated ESR test ordered to monitor their disease activity and response to therapy.
7. An individual with suspected polymyalgia rheumatica undergoes an automated ESR test as part of their diagnostic workup.
8. A patient with a fever of unknown origin has an automated ESR test performed to help identify potential causes of their symptoms.
9. An individual with a history of inflammatory bowel disease undergoes an automated ESR test to monitor their disease activity and response to treatment.
10. A patient with unexplained weight loss and night sweats has an automated ESR test ordered to evaluate for possible underlying inflammatory conditions.