How To Use CPT Code 85097

CPT 85097 describes the interpretation of a bone marrow smear by a clinician, typically a pathologist. 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 85097?

CPT 85097 can be used to describe the interpretation of a bone marrow smear by a clinician, usually a pathologist. This code is used when the clinician examines stained smears of bone marrow prepared in a laboratory or clinical setting. The clinician analyzes the types and quantities of blood cells and precursor cells, as well as any cellular abnormalities. They provide a descriptive analysis of the findings and may suggest additional procedures or tests to confirm a potential diagnosis indicated by the interpretation.

2. Official Description

The official description of CPT code 85097 is: ‘Bone marrow, smear interpretation only, with or without differential cell count.’

3. Procedure

1. The clinician receives a bone marrow smear prepared in a laboratory or clinical location.
2. They examine the stained smear, which consists of small amounts of bone marrow spread onto a glass slide.
3. The clinician analyzes the types and quantities of blood cells and precursor cells, as well as any cellular abnormalities.
4. They provide a descriptive analysis of the findings and may suggest additional procedures or tests to confirm a potential diagnosis indicated by the interpretation.

4. Qualifying circumstances

CPT 85097 is typically performed by a pathologist or other qualified clinician who specializes in interpreting bone marrow smears. The procedure is necessary when a patient’s condition requires a detailed analysis of their bone marrow cells. This may include cases of suspected blood disorders, leukemia, lymphoma, or other hematological conditions. The clinician must have the expertise to accurately interpret the smear and provide relevant clinical information.

5. When to use CPT code 85097

CPT code 85097 should be used when a clinician, typically a pathologist, performs the interpretation of a bone marrow smear. It is appropriate when the clinician examines the smear to analyze the types and quantities of blood cells, precursor cells, and any cellular abnormalities. This code should be used for the interpretation only and does not include any additional procedures or tests.

6. Documentation requirements

To support a claim for CPT 85097, the clinician must document the following information:

• Description of the bone marrow smear and any staining techniques used
• Analysis of the types and quantities of blood cells and precursor cells
• Identification of any cellular abnormalities
• Descriptive analysis of the findings
• Clinical conditions that could cause observed irregularities
• Recommendations for additional procedures or tests, if applicable
• Signature of the interpreting clinician

7. Billing guidelines

When billing for CPT 85097, ensure that the clinician performing the interpretation is a qualified pathologist or other clinician with expertise in bone marrow smear analysis. This code should be reported for the interpretation only and does not include any additional procedures or tests. It is important to follow any specific billing guidelines provided by the payer or relevant coding guidelines.

8. Historical information

CPT 85097 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A pathologist interpreting a bone marrow smear to analyze the types and quantities of blood cells for a patient suspected of having leukemia.
2. A hematologist examining a bone marrow smear to identify any cellular abnormalities in a patient with unexplained anemia.
3. A clinician specializing in lymphoma analyzing a bone marrow smear to determine the extent of lymphoma involvement in a patient.
4. A pathologist providing a descriptive analysis of a bone marrow smear for a patient with suspected myelodysplastic syndrome.
5. An oncologist requesting the interpretation of a bone marrow smear to guide treatment decisions for a patient with a hematological malignancy.
6. A hematopathologist examining a bone marrow smear to assess the response to treatment in a patient with multiple myeloma.
7. A clinician analyzing a bone marrow smear to identify any precursor cells in a patient with suspected aplastic anemia.
8. A pathologist interpreting a bone marrow smear to evaluate the effectiveness of chemotherapy in a patient with lymphoma.
9. An oncologist requesting the interpretation of a bone marrow smear to assess the presence of minimal residual disease in a patient with acute lymphoblastic leukemia.
10. A hematologist examining a bone marrow smear to investigate the cause of pancytopenia in a patient.