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The CPT® Code 85598 refers to a specific laboratory test known as the hexagonal phospholipid neutralization assay, which is utilized to detect the presence of lupus anticoagulants (LAs) in the blood. Lupus anticoagulants are a diverse group of antibodies that target phospholipid-protein complexes, leading to an increased clotting time in affected individuals. The assay operates on the principle that when a hexagonal phospholipid source is introduced to a sample containing LAs, these antibodies are neutralized, resulting in a shortened clotting time. This test employs a two-part activated partial thromboplastin time (aPTT)-based methodology, comparing the clotting times of samples tested with and without hexagonal phase phosphatidyl-ethanolamine (HPE) using a reagent sensitive to LAs. A significant difference in clotting times—specifically, if the clotting time without HPE exceeds that with HPE by 8 seconds or more—indicates a positive result for the presence of lupus anticoagulants. While a positive result may suggest systemic lupus erythematosus (SLE), it is important to note that many individuals with positive results do not have this condition. The test is particularly relevant for patients with a history of spontaneous abortion, thrombosis, or infections, as the ongoing presence of LAs in plasma is associated with an elevated risk of these complications, especially concerning arterial and venous thrombosis.
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The hexagonal phospholipid neutralization assay (CPT® Code 85598) is indicated for the evaluation of patients who may have lupus anticoagulants, particularly in the context of certain clinical conditions. The following indications are explicitly recognized for performing this assay:
The hexagonal phospholipid neutralization assay involves a series of procedural steps designed to accurately assess the presence of lupus anticoagulants in a blood sample. The following steps outline the procedure:
After the hexagonal phospholipid neutralization assay is completed, the results are analyzed and reported to the healthcare provider. If the test is positive for lupus anticoagulants, further evaluation and management may be necessary, particularly for patients with a history of complications such as thrombosis or pregnancy loss. It is essential for healthcare providers to interpret the results in conjunction with the patient's clinical history and other laboratory findings, as a positive result does not definitively indicate systemic lupus erythematosus (SLE) and may require additional testing or monitoring. Patients may be advised on follow-up care and potential treatment options based on the results of the assay and their overall clinical picture.
| Short Descr | HEXAGNAL PHOSPH PLTLT NEUTRL | Medium Descr | PHOSPHOLIPID NEUTRALIZATION HEXAGONAL | Long Descr | Phospholipid neutralization; hexagonal phospholipid | 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 |
| 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. | GA | Waiver of liability statement issued as required by payer policy, individual case | 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. | 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. | 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 | 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 | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q4 | Service for ordering/referring physician qualifies as a service exemption | 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 |
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| 2011-01-01 | Added | Added |
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