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The CPT® Code 85097 refers to the procedure of bone marrow smear interpretation, which is a critical laboratory test conducted by a physician or technician. This test involves the examination and interpretation of a bone marrow smear, which is a sample of bone marrow tissue that is spread thinly on a glass slide and stained for microscopic analysis. Bone marrow is a spongy tissue located within the bones, rich in hematopoietic stem cells responsible for the production of various blood components, including red blood cells (RBCs or erythrocytes), white blood cells (WBCs or leukocytes), and platelets (thrombocytes). In addition to these blood cells, bone marrow contains essential nutrients such as iron, vitamin B12, folate, and fat, which are vital for hematopoiesis—the process of blood cell formation. During the procedure, a bone marrow aspirate, core, or clot sample is obtained and prepared for analysis. The smear is then subjected to staining techniques that allow for the visualization of cellular components under a microscope. The interpretation of the smear includes a detailed assessment of the size, shape, and appearance of the cells, as well as the determination of the myeloid to erythroid ratio, which provides insight into the relative production of different blood cell types. Additionally, a differential count and maturation level of the total WBCs, RBCs, and platelets are evaluated. The presence of abnormal cells is noted, and the overall cellularity and structure of the marrow are reported if they are observable in the sample. Bone marrow smear interpretation is essential for diagnosing, staging, and monitoring various hematological conditions, including leukemia, anemia, thrombocytopenia, myelodysplastic syndromes, lymphoma, myeloma, and other malignancies. It is important to note that the collection of the bone marrow sample is a separate procedure that must be reported independently, and the smear analysis is performed using specialized staining techniques and microscopic examination to ensure accurate results.
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The bone marrow smear interpretation (CPT® Code 85097) is performed for several specific indications, primarily related to the assessment of hematological disorders. The following conditions may warrant this procedure:
The procedure for bone marrow smear interpretation involves several critical steps to ensure accurate analysis and reporting. The following outlines the procedural steps:
After the bone marrow smear interpretation is completed, the results are compiled into a comprehensive report that is shared with the referring physician. The report may indicate the presence of any abnormalities, the overall cellularity of the marrow, and any relevant findings that could impact patient management. Follow-up care may be necessary depending on the results, particularly if abnormalities are detected that require further investigation or treatment. It is important for healthcare providers to discuss the findings with the patient and determine any additional steps needed for diagnosis or management of the underlying conditions.
| Short Descr | BONE MARROW INTERPRETATION | Medium Descr | BONE MARROW SMEAR INTERPRETATION | Long Descr | Bone marrow, smear interpretation | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | T-Packaged Codes | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | T1G - Lab tests - other (Medicare fee schedule) | MUE | 2 | CCS Clinical Classification | 206 - Microscopic examination (bacterial smear, culture, toxicology) |
This is a primary code that can be used with these additional add-on codes.
| 0855T | Add On Code Resequenced Code MPFS Status: Carrier Priced APC N Digitization of glass microscope slides for bone marrow, smear interpretation (List separately in addition to code for primary procedure) |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | CR | Catastrophe/disaster related | 59 | 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. | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 90 | Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number. | 91 | Repeat clinical diagnostic laboratory test: in the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. note: this modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. this modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). this modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient. | AI | Principal physician of record | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | Q5 | Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
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| 2024-01-01 | Changed | Guideline information changed. |
| 2002-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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