CPT® Code 85009

Official Description

Blood count; manual differential WBC count, buffy coat

Common Language Description

A manual differential white blood cell (WBC) count is a laboratory procedure that provides a detailed analysis of the various types of white blood cells present in a blood sample. This process utilizes a technique known as the buffy coat method, which involves the separation of blood components through centrifugation. During this procedure, a blood sample is collected via venipuncture, which is a standard method for obtaining blood. The collected blood is then placed into a microhematocrit tube and subjected to centrifugation, a process that spins the sample at high speeds to separate its components based on density. The result of this separation is the formation of a distinct layer known as the buffy coat, which contains the white blood cells situated between the red blood cells (RBCs) and plasma. The primary purpose of performing a manual differential WBC count is to estimate the total WBC count and to analyze the proportions of the different types of white blood cells. This count is crucial for diagnosing various medical conditions, as changes in the levels of specific WBC types can indicate underlying health issues. The technician conducting the analysis will identify and count each of the five main types of WBCs: neutrophils, eosinophils, basophils, monocytes, and lymphocytes. Each type of WBC has distinct characteristics and functions, contributing to the body's immune response. For instance, neutrophils are the most abundant type of WBC in healthy adults and play a key role in fighting infections. Eosinophils are involved in allergic reactions and responses to parasitic infections, while basophils are associated with inflammatory responses. Monocytes serve as scavengers, cleaning up cellular debris, and lymphocytes are essential for the production of antibodies. This comprehensive analysis aids healthcare providers in diagnosing and monitoring various conditions, including infections, allergies, and hematological disorders.

1. Indications

The manual differential white blood cell (WBC) count is performed for several specific indications, which include the following:

Evaluation of Infection The procedure is commonly indicated when there is a suspicion of an infection, as changes in WBC counts can help identify the presence and type of infection.
Assessment of Allergic Reactions It is utilized to evaluate allergic responses, particularly when elevated eosinophil levels are suspected.
Monitoring Hematological Disorders The test is indicated for monitoring patients with known hematological disorders, such as leukemias or other blood-related conditions.
Investigation of Inflammatory Conditions It is performed to investigate various inflammatory conditions, as changes in WBC counts can indicate the presence of inflammation.
Preoperative Assessment The procedure may be indicated as part of a preoperative workup to ensure that the patient is in a suitable condition for surgery.

2. Procedure

The procedure for conducting a manual differential WBC count using the buffy coat method involves several key steps, which are detailed below:

Step 1: Blood Collection A blood sample is obtained from the patient through a venipuncture, which is the process of puncturing a vein to draw blood. This step is crucial as it provides the specimen needed for the analysis.
Step 2: Centrifugation The collected blood sample is then placed into a microhematocrit tube and subjected to centrifugation. This process involves spinning the tube at high speeds, which separates the blood components based on their density. The result is the formation of three distinct layers: the bottom layer contains red blood cells, the middle layer is the buffy coat containing white blood cells, and the top layer is plasma.
Step 3: Identification of Buffy Coat After centrifugation, the technician carefully identifies the buffy coat layer, which is a thin layer of white cells situated between the red blood cells and plasma. This layer is critical for estimating the WBC count.
Step 4: Manual Differential Count The technician then performs a manual differential WBC count by examining a stained smear of the buffy coat under a microscope. This involves identifying and counting each of the five types of white blood cells: neutrophils, eosinophils, basophils, monocytes, and lymphocytes. Each type is differentiated based on its unique characteristics, such as size, shape, and staining properties.
Step 5: Documentation of Results Finally, the results of the manual differential WBC count are documented, providing a detailed breakdown of the proportions of each type of white blood cell. This information is essential for further analysis and interpretation by healthcare providers.

3. Post-Procedure

Post-procedure care for a manual differential WBC count is generally minimal, as the procedure is non-invasive and involves only a blood draw. Patients may be advised to apply pressure to the venipuncture site to minimize any potential bleeding or bruising. It is also important for patients to be informed about any specific follow-up actions, such as monitoring for any unusual symptoms or complications. The results of the WBC count will typically be reviewed by the healthcare provider, who will discuss the findings with the patient and determine if any further testing or treatment is necessary based on the results.

Short Descr	MANUAL DIFF WBC COUNT B-COAT
Medium Descr	BLOOD COUNT MANUAL DIFRNTL WBC COUNT BUFFY COAT
Long Descr	Blood count; manual differential WBC count, buffy coat
Status Code	Statutory Exclusion (from MPFS, may be paid under other methodologies)
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
CLIA Waived (QW)	No
APC Status Indicator	Conditionally packaged laboratory tests
Type of Service (TOS)	5 - Diagnostic Laboratory
Berenson-Eggers TOS (BETOS)	T1D - Lab tests - blood counts
MUE	1
CCS Clinical Classification	233 - Laboratory - Chemistry and Hematology

Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.

Attending physician not employed or paid under arrangement by the patient's hospice provider