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The CPT® Code 85396 refers to a coagulation/fibrinolysis assay performed on whole blood, which is a laboratory test designed to evaluate the body's ability to form and dissolve blood clots. This assay utilizes pharmacologic additives as necessary to enhance the assessment process. The primary purpose of this test is to provide a comprehensive evaluation of a patient's risk for hemorrhage or thrombosis by measuring various components involved in the clotting cascade. Key elements assessed include the rate of clot formation, the strength of the clot, and its stability, which are determined through the analysis of fibrin formation, platelet function, and fibrinolytic activity. The whole blood assay is particularly valuable in clinical scenarios involving acute bleeding or major trauma, as it offers a broad perspective on hemostatic imbalances that may be present. This information is crucial for guiding appropriate transfusion support and other therapeutic interventions. The test is conducted by obtaining a blood sample, which can be collected through a separately reportable venipuncture, arterial draw, or central line draw. The analysis is performed using thromboelastogram (TEG) techniques, specifically with the addition of plain kaolin and heparinase to the whole blood sample. Following the assay, a written report is generated by a pathologist or another qualified professional, detailing patient-specific diagnostic information, treatment strategies, and recommendations for future testing options.
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The coagulation/fibrinolysis assay (CPT® Code 85396) is indicated for use in various clinical situations where assessment of hemostatic function is necessary. The following conditions may warrant the performance of this assay:
The procedure for conducting the coagulation/fibrinolysis assay involves several key steps that ensure accurate assessment of the patient's hemostatic function. The following outlines the procedural steps:
Post-procedure care following the coagulation/fibrinolysis assay primarily involves monitoring the patient for any adverse reactions related to the blood draw and ensuring that the results are communicated effectively to the healthcare team. The written report generated from the assay should be reviewed promptly to inform clinical decision-making regarding treatment options and potential follow-up testing. Additionally, healthcare providers should consider the implications of the assay results on the patient's ongoing management, particularly in cases of acute bleeding or thrombotic risk.
| Short Descr | CLOTTING ASSAY WHOLE BLOOD | Medium Descr | COAGJ/FBRNLYS ASSAY WHOLE BLOOD ADDITIVE PER DAY | Long Descr | 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 | 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 | Items and Services Packaged into APC Rates | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | T1G - Lab tests - other (Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 233 - Laboratory - Chemistry and Hematology |
| 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. | 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. | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | 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. | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition |
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| 2011-01-01 | Changed | Short description changed. |
| 2004-01-01 | Added | First appearance in code book in 2004. |
| 1986-12-31 | Deleted | Code deleted. |
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