2025 CPT code 85999
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Pathology and Laboratory Procedures - Unlisted Hematology and Coagulation Procedure Hematology and Coagulation Procedures Feed
Unlisted hematology and coagulation procedure.
Modifiers may be applicable depending on the circumstances of the service provided. Consult the CPT manual for appropriate modifier usage.
Medical necessity must be established by the ordering physician, documenting the clinical indication for the unlisted procedure and its relevance to the patient's diagnosis or treatment plan. The payer may require additional documentation to support medical necessity.
The clinical responsibility lies with the laboratory personnel performing and interpreting the unlisted hematology or coagulation test. The ordering physician is responsible for medical necessity and appropriate test selection.
In simple words: This code is used for blood tests and clotting factor tests when there isn't a specific code for the particular test done.The doctor's office needs to explain why this code was used and provide detailed information about the test performed.
This CPT code reports hematology and coagulation procedures not otherwise specified in the CPT codebook (codes 85002-85810) or within the Chemistry (82009-84830), Immunology (86015-86835), or Transfusion Medicine (86850-86985) sections.Use this code only when no other appropriate CPT code exists.Detailed documentation justifying the use of this unlisted code, along with a comparison to similar coded procedures, is required for reimbursement.
Example 1: A patient presents with unusual bleeding tendencies.The laboratory performs a specialized coagulation assay not covered by a specific CPT code, requiring the use of 85999.Detailed methodology and results are documented., A patient with a history of leukemia undergoes a rare flow cytometry analysis to detect a specific leukemic cell subtype not included in standard panels.Code 85999 is used. The laboratory report describes the specialized cell markers, methodology, and findings., During a bone marrow biopsy, an unusual cell population is detected.The laboratory performs advanced molecular analysis to characterize this population, needing code 85999. A detailed report explaining the molecular techniques, target genes, and results is provided.
Comprehensive laboratory reports detailing the procedure performed, methodology employed, materials used, results obtained, and interpretation.A cover letter explaining why this unlisted code was used is mandatory.
** Accurate and detailed documentation is paramount for successful reimbursement when using CPT code 85999.Pre-authorization may be required by certain payers. This code should be used judiciously, only when no other appropriate code exists.
- Revenue Code: T1H (LAB TESTS - OTHER)
- RVU: Relative Value Units (RVUs) will vary based on the specific unlisted procedure performed and local payer rules.Documentation supporting the work involved is crucial for accurate RVU assignment and payment.
- Global Days: Not applicable.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Historical fee schedules are not readily available for unlisted codes.Reimbursement will vary based on the specific procedure, payer, and documentation provided.
- Specialties:Hematology, Oncology, Pathology, Clinical Laboratory
- Place of Service:Office, Hospital (Inpatient/Outpatient), Clinical Laboratory