2025 CPT code 85396
(Active) Effective Date: N/A Pathology and Laboratory Procedures - Hematology and Coagulation Procedures Feed
Coagulation/fibrinolysis assay, whole blood (e.g., viscoelastic clot assessment), including use of any pharmacologic additive(s), as indicated, including interpretation and written report, per day.
Medical necessity for TEG is established when it is required to provide real-time, comprehensive assessment of blood clotting function, which is essential for guiding treatment decisions in specific clinical situations like major surgery, trauma, or bleeding disorders. TEG offers a more complete picture compared to standard tests like PT and aPTT.
The physician or qualified healthcare practitioner is responsible for interpreting the TEG findings, including comparing them with other coagulation tests, determining the clinical relevance of the results, and preparing a report of the overall findings.
In simple words: This test checks how well your blood clots and breaks down clots over a period of up to one day. It uses a special method called TEG, which looks at the whole process of clot formation and how stable the clot is. The doctor uses this information, along with other blood tests, to get a complete picture of how your blood is clotting.
This code represents the evaluation of ongoing coagulation/fibrinolysis monitoring in whole blood, using methods like thrombelastography (TEG), for a full day or part of a day. It includes the interpretation of TEG findings, which may involve automated testing of hemostasis, clot formation, and fibrinolysis, sometimes using chemical inhibitors. This evaluation might occur during or after procedures like surgery. The physician compares TEG results with other coagulation tests, interprets the clinical significance, and prepares a comprehensive report. This test is often used to evaluate abnormalities in plasma components affecting coagulation and fibrinolysis, or to assess clotting process and stability.
Example 1: A patient undergoing open-heart surgery requires ongoing monitoring of their blood clotting function. TEG is used throughout the procedure to assess the patient's hemostatic status and guide transfusion decisions., A patient with a suspected bleeding disorder undergoes TEG to evaluate the dynamics of clot formation and breakdown, providing a comprehensive picture of their coagulation system., A trauma patient admitted to the emergency department needs rapid assessment of their coagulation status. TEG helps identify any abnormalities and guides appropriate interventions to control bleeding.
Documentation should include the reason for the TEG, details of the procedure, interpretation of the TEG graph, comparison with other coagulation tests (if performed), and a summary of the clinical findings. The medical necessity of the procedure must also be documented.
- Specialties:Anesthesiology, Hematology, Critical Care Medicine, Surgery, Trauma Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center, Emergency Room - Hospital, Independent Laboratory