CPT® Code 85461

Official Description

Hemoglobin or RBCs, fetal, for fetomaternal hemorrhage; rosette

Common Language Description

The CPT® Code 85461 refers to a laboratory test specifically designed to measure fetal hemoglobin or red blood cells (RBCs) in maternal blood, particularly in the context of fetomaternal hemorrhage (FMH). This test serves as a qualitative screening tool that is typically ordered when there is a suspicion of a larger than expected FMH, which can occur during pregnancy or delivery. The mixing of fetal blood with maternal blood can have significant implications, especially for Rh-negative women carrying an Rh-positive fetus. In such cases, the transfer of fetal cells into the maternal circulation may lead to maternal Rh immunization, posing risks for future pregnancies. A positive result from this qualitative screening test necessitates further investigation through a quantitative test, specifically CPT® Code 85460, to accurately determine the appropriate dosage of Rh immune globulin (RhoGAM) that should be administered to the mother either postpartum or after a preterm fetal loss. The test is conducted by obtaining a blood sample through a venipuncture, which is a separately reportable procedure, and the analysis is performed on whole blood using a technique known as red blood cell rosetting.

1. Indications

The CPT® Code 85461 is indicated for use in specific clinical scenarios where there is a concern for fetomaternal hemorrhage (FMH). The following conditions may warrant the performance of this test:

Suspected Fetomaternal Hemorrhage A larger than expected FMH may occur during pregnancy or delivery, necessitating this test to assess fetal blood presence in maternal circulation.
Rh-negative Mother with Rh-positive Fetus In cases where an Rh-negative woman is pregnant with an Rh-positive fetus, the risk of maternal Rh immunization is present, making this test crucial for monitoring and management.

2. Procedure

The procedure for CPT® Code 85461 involves several key steps that ensure accurate testing for fetal hemoglobin or RBCs in maternal blood. The following procedural steps are outlined:

Step 1: Patient Preparation The patient, typically an Rh-negative pregnant woman, is prepared for the blood draw. This may involve explaining the procedure and obtaining informed consent.
Step 2: Venipuncture A blood sample is obtained through venipuncture, which is a separate reportable procedure. The healthcare provider will select an appropriate site, usually in the arm, to draw the blood sample.
Step 3: Sample Processing The collected whole blood sample is then processed in the laboratory. The testing method employed is red blood cell rosetting, which allows for the identification of fetal RBCs within the maternal blood sample.
Step 4: Result Interpretation The results of the qualitative screening test are interpreted. A positive result indicates the presence of fetal hemoglobin, which may necessitate further quantitative testing to determine the appropriate dose of Rh immune globulin (RhoGAM).

3. Post-Procedure

After the procedure associated with CPT® Code 85461, the patient may be monitored for any immediate complications related to the venipuncture. If the qualitative screening test yields a positive result, it is essential to follow up with a quantitative test (CPT® Code 85460) to ascertain the exact amount of fetal blood present. This information is critical for determining the dosage of Rh immune globulin (RhoGAM) that should be administered to the mother, particularly in the postpartum period or following a preterm fetal loss. Additionally, healthcare providers should ensure that the patient is informed about the results and any necessary subsequent steps in her care plan.

Short Descr	HEMOGLOBIN FETAL
Medium Descr	HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE
Long Descr	Hemoglobin or RBCs, fetal, for fetomaternal hemorrhage; rosette
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)	T1H - Lab tests - other (non-Medicare fee schedule)
MUE	1
CCS Clinical Classification	233 - Laboratory - Chemistry and Hematology

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.