CPT® Code 85460

1. Indications

The CPT® Code 85460 is indicated for use in specific clinical scenarios where there is a concern for fetomaternal hemorrhage (FMH). The following conditions warrant the performance of this test:

• Pregnancy with Rh Incompatibility - This test is crucial for Rh-negative women who are pregnant with an Rh-positive fetus, as it helps assess the risk of maternal Rh immunization.
• Assessment of Fetomaternal Hemorrhage - It is indicated when there is a suspicion of FMH, which can occur during pregnancy or delivery, potentially leading to complications for both the mother and fetus.
• Postpartum Evaluation - The test is performed postpartum to determine the extent of FMH, which aids in deciding the appropriate dose of Rh immune globulin (RhoGAM) to administer to the mother.
• Preterm Fetal Loss - In cases of preterm fetal loss, this test can help evaluate the extent of fetal blood transfer to the maternal circulation.

2. Procedure

The procedure for performing the test associated with CPT® Code 85460 involves several critical steps to ensure accurate measurement of fetal hemoglobin in maternal blood. The following outlines the procedural steps:

• Step 1: Blood Sample Collection - A blood sample is obtained from the mother through a venipuncture. This step is essential as it provides the whole blood necessary for the subsequent analysis. The venipuncture must be performed in a sterile manner to prevent contamination and ensure the integrity of the sample.
• Step 2: Preparation of the Sample - Once the blood sample is collected, it is prepared for testing. This involves the application of an acid elution technique, which selectively lyses maternal red blood cells while preserving fetal hemoglobin. This step is critical for differentiating between maternal and fetal blood components.
• Step 3: Staining and Microscopy - The prepared sample undergoes staining with eosin, which allows for the visualization of fetal hemoglobin under a microscope. The semi-quantitative nature of this staining process enables the laboratory technician to assess the percentage of fetal hemoglobin present in the maternal blood sample accurately.
• Step 4: Analysis and Reporting - After microscopy, the results are analyzed, and the percentage of fetal hemoglobin is quantified. This information is then compiled into a report that is provided to the healthcare provider for further clinical decision-making.

3. Post-Procedure

After the completion of the test associated with CPT® Code 85460, there are several important considerations for post-procedure care. The mother may experience minimal discomfort at the venipuncture site, which typically resolves quickly. It is essential for healthcare providers to review the test results promptly, as the quantification of fetal hemoglobin can significantly influence the management of the mother, particularly regarding the administration of Rh immune globulin (RhoGAM). If the test indicates a significant level of fetomaternal hemorrhage, appropriate interventions should be initiated to mitigate any potential risks to future pregnancies. Additionally, healthcare providers should ensure that the mother is informed about the results and any necessary follow-up actions that may be required based on the findings of the test.