How To Use CPT Code 85004

CPT 85004 describes the automated differential white blood cell count, a procedure performed by a lab analyst to determine the number of each different type of white blood cells present in a patient’s blood sample. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 85004?

CPT 85004 is used to describe the automated differential white blood cell count, which is a laboratory procedure performed by a lab analyst. The analyst analyzes a sample of the patient’s blood on a slide and uses an automated system to determine the number of each different type of white blood cells present. This test helps clinicians assess if the patient’s white blood cells are in proper proportion or if there is an abnormally high or low count of one or more white blood cell types, which may indicate a disease or condition.

2. Official Description

The official description of CPT code 85004 is: ‘Blood count; automated differential white blood cell count.’

3. Procedure

1. The lab analyst smears the patient’s blood sample on a slide.
2. The slide is then stained and placed on a specially-designed apparatus.
3. The automated system counts the number of each of the five types of white blood cells: neutrophils, lymphocytes (including B cells and T cells), monocytes, eosinophils, and basophils.

4. Qualifying circumstances

CPT 85004 is commonly ordered by clinicians to determine if the patient’s white blood cells are in proper proportion or if there is an abnormal count of one or more white blood cell types. This test can help indicate various conditions, such as infections, autoimmune diseases, and certain types of cancer. It is not limited to testing for a specific condition and can assist clinicians in focusing further diagnostic testing.

5. When to use CPT code 85004

CPT code 85004 should be used when a lab analyst performs an automated differential white blood cell count. It is appropriate to bill this code when the test is ordered by a clinician to assess the patient’s white blood cell count and proportions. However, it is important to note that if the clinician orders a comprehensive test that includes an automated differential white blood cell count along with other tests, a different code should be used to describe the comprehensive test.

6. Documentation requirements

To support a claim for CPT 85004, the documentation should include:

• Indication of why the test was ordered
• Results of the automated differential white blood cell count
• Any additional relevant information or findings

7. Billing guidelines

When billing for CPT 85004, ensure that the test is performed by a lab analyst using an automated system. It is important to follow the specific guidelines provided by payers regarding the reporting of this code. If the test is performed as part of a comprehensive test, a different code should be used to describe the comprehensive test rather than reporting CPT 85004 and another code separately.

8. Historical information

CPT 85004 was added to the Current Procedural Terminology system on January 1, 2003. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performs an automated differential white blood cell count on a patient’s blood sample to assess their white blood cell count and proportions.
2. A clinician orders an automated differential white blood cell count to determine if a patient’s elevated neutrophil count is associated with an acute infection.
3. An automated differential white blood cell count is performed to assess a patient’s lymphocyte count, which may indicate a viral infection.
4. A lab analyst uses an automated system to count the number of eosinophils in a patient’s blood sample, helping to diagnose an allergic reaction.
5. An automated differential white blood cell count is performed to evaluate a patient’s monocyte count, which may indicate a chronic inflammatory condition.
6. A clinician orders an automated differential white blood cell count to assess a patient’s basophil count, which may be elevated in certain allergic or autoimmune conditions.
7. A lab analyst performs an automated differential white blood cell count to determine the proportions of different white blood cell types in a patient with suspected leukemia.
8. An automated differential white blood cell count is performed to assess a patient’s white blood cell count and proportions before a surgical procedure.
9. A clinician orders an automated differential white blood cell count to monitor a patient’s response to treatment for an infection.
10. A lab analyst performs an automated differential white blood cell count to evaluate a patient’s white blood cell count and proportions as part of a routine health check-up.