© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 86152 refers to a specialized laboratory test known as cell enumeration, which utilizes immunologic selection and identification techniques on fluid specimens, such as blood. This test is particularly significant in the context of oncology, as it is designed to detect circulating tumor cells (CTCs) in patients who have been diagnosed with cancer. The presence of these tumor cells in bodily fluids is indicative of metastatic disease, which is the process by which cancer spreads from its original site to other parts of the body through the circulatory system, including blood, bone marrow, and lymphatic pathways. Identifying circulating tumor cells can provide critical insights into the prognosis of the disease and inform treatment decisions for various types of cancer, including but not limited to breast, colorectal, prostate, renal, bladder, and non-small cell lung cancers. The detection of these cells is often associated with a poorer survival rate, making this test a valuable tool in the management of cancer patients. The procedure typically involves obtaining a blood sample through a separately reportable venipuncture, while other body fluids may be collected via different methods, such as a bone marrow biopsy for bone marrow samples or alternative techniques for lymphatic fluid. The blood sample may be analyzed using a cell search method, which yields a positive result if five or more circulating tumor cells are identified, or through morphological appearance, which necessitates microscopic examination to visualize the cells. Additionally, a physician's interpretation and report may be required to provide a comprehensive understanding of the test results. For billing purposes, the code 86152 is used for the cell enumeration test, while 86153 is designated for any necessary physician interpretation and reporting associated with the test.
© Copyright 2025 Coding Ahead. All rights reserved.
The cell enumeration test using CPT® Code 86152 is indicated for patients diagnosed with various types of cancer. The presence of circulating tumor cells in body fluids can provide valuable information regarding the prognosis and treatment options for the following conditions:
The procedure for cell enumeration using CPT® Code 86152 involves several key steps to ensure accurate identification of circulating tumor cells in fluid specimens. The first step is the collection of the appropriate fluid sample, which is typically blood obtained through a venipuncture. This process is performed by a qualified healthcare professional who will insert a needle into a vein to draw the necessary volume of blood. In cases where other body fluids are required, such as bone marrow or lymphatic fluid, alternative collection methods like bone marrow biopsy or other techniques may be employed.
After the cell enumeration procedure, patients may be monitored for any immediate reactions to the blood draw or fluid collection. The results of the test will typically be available within a specified timeframe, depending on the laboratory's processing capabilities. It is essential for healthcare providers to discuss the findings with the patient, as the presence of circulating tumor cells can significantly impact the prognosis and treatment options. Follow-up appointments may be scheduled to review the results in detail and to determine the next steps in the patient's care plan. Additionally, if a physician's interpretation is required, it will be documented and reported separately, using CPT® Code 86153 for billing purposes.
| Short Descr | CELL ENUMERATION & ID | Medium Descr | CELL ENUMERATION IMMUNE SELECTJ & ID FLUID SPEC | Long Descr | Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); | 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 | 235 - Other Laboratory |
| 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. | GZ | Item or service expected to be denied as not reasonable and necessary | 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. | 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. |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2013-01-01 | Added | Added |
Get instant expert-level medical coding assistance.