How To Use CPT Code 85396

CPT 85396 describes the evaluation and ongoing monitoring of coagulation and fibrinolysis in whole blood, including the use of pharmacologic additives, as indicated. 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 85396?

CPT 85396 can be used to evaluate and monitor coagulation and fibrinolysis in whole blood for all or part of one day. This code is used when a physician or qualified healthcare practitioner interprets the findings of thrombelastography (TEG), which assesses clot formation and breakdown. The provider may use chemical agents as inhibitors during the testing process. The purpose of this code is to evaluate possible abnormalities in plasma components that impact coagulation and fibrinolysis.

2. Official Description

The official description of CPT code 85396 is: ‘Coagulation/fibrinolysis assay, whole blood (eg, viscoelastic clot assessment), including use of any pharmacologic additive(s), as indicated, including interpretation and written report, per day.’

3. Procedure

1. The physician or qualified healthcare practitioner performs ongoing monitoring of coagulation and fibrinolysis in whole blood for all or part of one day.
2. Thrombelastography (TEG) is conducted, which involves automated testing of hemostasis in whole blood, including clot formation and fibrinolysis.
3. Chemical agents may be used as inhibitors during the TEG testing process.
4. The provider compares the TEG findings with other coagulation tests, such as partial thromboplastin time, to determine clinically meaningful results.
5. A report is prepared summarizing the overall findings of the evaluation.

4. Qualifying circumstances

CPT 85396 is used when ongoing monitoring of coagulation and fibrinolysis in whole blood is necessary. This procedure is not limited to testing for a specific condition but is ordered as a comprehensive test to evaluate possible abnormalities in plasma components that impact coagulation and fibrinolysis. Only a physician or other qualified healthcare practitioner can bill for this service.

5. When to use CPT code 85396

CPT code 85396 should be used when ongoing monitoring of coagulation and fibrinolysis in whole blood is required. It is appropriate to bill this code once each day if TEG and other coagulation testing is ongoing. This code should not be reported with other codes for the same service.

6. Documentation requirements

To support a claim for CPT 85396, the physician or qualified healthcare practitioner must document the following information:

• Reason for ordering the evaluation and ongoing monitoring of coagulation and fibrinolysis
• Specific tests performed, including thrombelastography (TEG) and any pharmacologic additives used
• Date(s) of service and duration of monitoring
• Comparison of TEG findings with other coagulation tests
• Clinically meaningful results and overall findings
• Preparation of a written report summarizing the evaluation

7. Billing guidelines

When billing for CPT 85396, ensure that the service is performed by a physician or qualified healthcare practitioner. This code should not be reported with other codes for the same service. Medicare pays for this procedure on the physician fee schedule. The unit of service for CPT 85396 is per day, so the practitioner can bill this code once each day if ongoing monitoring is necessary.

8. Historical information

CPT 85396 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 physician evaluating ongoing coagulation and fibrinolysis in whole blood for a patient undergoing open heart surgery.
2. A qualified healthcare practitioner monitoring coagulation and fibrinolysis in whole blood for a patient with a bleeding disorder.
3. A physician interpreting thrombelastography (TEG) findings and comparing them with other coagulation tests for a patient with suspected coagulation abnormalities.
4. A qualified healthcare practitioner preparing a written report summarizing the evaluation of coagulation and fibrinolysis in whole blood for a patient with liver disease.
5. A physician conducting ongoing monitoring of coagulation and fibrinolysis in whole blood for a patient receiving anticoagulant therapy.
6. A qualified healthcare practitioner performing thrombelastography (TEG) and interpreting the findings for a patient undergoing a surgical procedure.
7. A physician comparing TEG findings with other coagulation tests to evaluate coagulation and fibrinolysis in whole blood for a patient with a history of blood clots.
8. A qualified healthcare practitioner monitoring coagulation and fibrinolysis in whole blood for a patient with a family history of bleeding disorders.
9. A physician preparing a written report summarizing the evaluation of coagulation and fibrinolysis in whole blood for a patient with a suspected coagulation disorder.
10. A qualified healthcare practitioner conducting ongoing monitoring of coagulation and fibrinolysis in whole blood for a patient undergoing a liver transplant.