How To Use CPT Code 85055

CPT 85055 describes the reticulated platelet assay, a laboratory test that evaluates a blood specimen to determine the percentage of reticulated platelets present. 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 85055?

CPT 85055 is a laboratory test that measures the percentage of reticulated platelets in a blood specimen. Reticulated platelets are immature platelets that can indicate disorders of platelet production, such as thrombocytopenia. This test helps clinicians assess the patient’s ability to form blood clots effectively.

2. Official Description

The official description of CPT code 85055 is: ‘Reticulated platelet assay.’

3. Procedure

1. The lab analyst receives a blood specimen and processes it with specific chemical markers.
2. The analyst then quantifies the percentage of reticulated platelets present in the blood specimen using methods like flow cytometry.
3. The test results provide information about the patient’s platelet production and their ability to form blood clots effectively.

4. Qualifying circumstances

CPT 85055 is ordered for patients with suspected disorders of platelet production, such as thrombocytopenia. It helps clinicians evaluate the patient’s ability to form blood clots effectively. The test is performed by a lab analyst who specializes in hematology and coagulation procedures.

5. When to use CPT code 85055

CPT code 85055 should be used when a clinician suspects a disorder of platelet production that can interfere with blood clot formation, such as thrombocytopenia. It is not limited to testing for a specific condition but can be ordered based on clinical judgment and suspicion of platelet-related disorders.

6. Documentation requirements

To support a claim for CPT 85055, the documentation should include:

• Reason for ordering the test, such as suspected disorders of platelet production
• Test results indicating the percentage of reticulated platelets present in the blood specimen
• Signature of the lab analyst who performed the test

7. Billing guidelines

When billing for CPT 85055, ensure that the test is performed by a lab analyst specializing in hematology and coagulation procedures. It is important to follow the specific guidelines provided by the payer regarding billing for specimen collection, such as using a separate code for venipuncture (e.g., 36415).

8. Historical information

CPT 85055 was added to the Current Procedural Terminology system on January 1, 2004. There have been no updates to the code since its addition.

9. Examples

1. A patient with suspected thrombocytopenia undergoes a reticulated platelet assay to assess their platelet production.
2. A clinician orders a reticulated platelet assay for a patient with a suspected disorder of platelet production that may affect blood clot formation.
3. A patient with a history of abnormal bleeding undergoes a reticulated platelet assay to evaluate their ability to form blood clots effectively.
4. A clinician suspects a platelet-related disorder in a patient and orders a reticulated platelet assay to aid in diagnosis.
5. A patient with a known platelet disorder undergoes regular reticulated platelet assays to monitor their platelet production and blood clotting ability.
6. A clinician orders a reticulated platelet assay for a patient before a surgical procedure to assess their risk of excessive bleeding.
7. A patient with a family history of platelet disorders undergoes a reticulated platelet assay as a precautionary measure.
8. A clinician orders a reticulated platelet assay for a patient with unexplained bruising and bleeding to investigate potential platelet abnormalities.
9. A patient with a suspected disorder affecting platelet production undergoes a reticulated platelet assay to aid in diagnosis and treatment planning.
10. A clinician orders a reticulated platelet assay for a patient with a known platelet disorder to monitor their response to treatment.