Summary & Overview
CPT 85390: Interpretation and Report of Fibrinolysis and Coagulation
CPT code 85390 covers professional interpretation and reporting of laboratory tests that evaluate fibrinolysis and coagulation. This service is relevant nationally because coagulation testing informs diagnosis and management of bleeding and thrombotic disorders and often triggers downstream clinical decisions and additional testing. CPT code 85390 is used when a physician or qualified nonphysician laboratory professional reviews coagulation/fibrinolysis data and issues a formal interpretation and report.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how CPT code 85390 is defined clinically, typical sites of service, and which payers commonly cover professional interpretation of coagulation studies. The publication outlines common modifiers associated with laboratory professional services and notes where input data are not available.
The report provides practical benchmarks and policy-relevant context for billing and coding teams, laboratory directors, and compliance staff. Topics covered include national reimbursement and coding considerations, clinical context for use of the code in evaluating hemostasis and fibrinolysis, and operational notes for laboratory service lines. Data not available in the input are identified as such where applicable.
Billing Code Overview
CPT code 85390 describes a service in which a physician or a nonphysician laboratory professional provides interpretation and a written report of laboratory tests used to evaluate fibrinolysis and coagulation. This involves clinical review of laboratory data related to blood clotting and clot breakdown to inform diagnosis and management of coagulation disorders.
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Service type: Clinical laboratory interpretation and reporting
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Typical site of service: Clinical laboratory, hospital laboratory, or outpatient diagnostic laboratory setting
Clinical & Coding Specifications
Clinical Context
A 62-year-old hospitalized patient on therapeutic anticoagulation presents with new-onset bleeding and an elevated international normalized ratio (INR). The treating team orders laboratory evaluation for coagulation and fibrinolysis to determine cause and guide reversal strategy. A hospital-based pathologist or qualified nonphysician laboratory professional interprets the coagulation panel, including thrombin time, fibrinogen, D-dimer, euglobulin lysis time, and other specialized assays, and issues a formal interpretive report. Typical workflow: clinician orders tests; specimen collected in the hospital lab or outpatient phlebotomy; laboratory technologists perform assays; a laboratory professional reviews raw results, integrates prior coagulation studies and medication history, documents interpretive comments and recommendations in the laboratory information system, and transmits the signed report to the ordering provider and the electronic medical record. Typical site of service is the hospital laboratory or independent clinical laboratory performing specialized coagulation testing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the interpretation/report by the laboratory professional separate from the technical testing performed by the lab (technical component billed separately). |
TC | Technical component | Use when billing only the technical component of the laboratory test (instrumentation, reagents, technologist time) without the professional interpretation. |
90 | Reference (outside) laboratory | Use when the specimen is sent to an outside reference laboratory for testing and the billing entity is the submitting laboratory. |
91 | Repeat clinical diagnostic laboratory test | Use when the same test is performed on the same day on the same patient to confirm prior result. |
59 | Distinct procedural service | Use when another non-overlapping procedure or service is performed on the same day and it is appropriate to indicate the services are separate and distinct. |
76 | Repeat procedure or service by same physician | Use when the interpretation/report is repeated by the same provider for a subsequent specimen or repeat testing. |
77 | Repeat procedure by another physician | Use when an interpretation/report is performed by a different provider than the original for repeat testing (Note: 77 not in provided list; therefore not included). |
90 | Reference (outside) laboratory | Data duplicate entry avoided by listing once; see above. |
59 | Distinct procedural service | Duplicate entry avoided by listing once; see above. |
52 | Reduced services | Use when limited testing or a partial panel is performed resulting in reduced work relative to usual service. |
53 | Discontinued procedure | Use when testing was started but discontinued for patient safety or specimen issues and a partial interpretive report is necessary. |
22 | Increased procedural services | Use when the interpretation required substantially greater work or complexity than typical and documentation supports additional work. |
24 | Unrelated E/M during postoperative period | Not applicable to this lab procedure; excluded. |
90 | Reference laboratory | Duplicate previously listed; see primary entries. |
Associated provider taxonomies:
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| Data not available in the input. | Data not available in the input. | Data not available in the input. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
D68.4 | Acquired coagulation factor deficiency | Common indication for detailed coagulation interpretation to identify factor deficiencies contributing to bleeding. |
D69.6 | Thrombocytopenia, unspecified | Low platelet counts impact hemostasis; coagulation/fibrinolysis interpretation helps differentiate platelet vs coagulation defects. |
D68.5 | Primary thrombophilia | Evaluation of fibrinolysis and coagulation can assess prothrombotic states when thrombotic events occur. |
R79.1 | Abnormal coagulation profile | Directly linked to the need for interpretive laboratory reporting to explain abnormal coagulation results. |
T45.515A | Adverse effect of anticoagulants, initial encounter | Used when anticoagulant-related bleeding or suspicion thereof prompts coagulation/fibrinolysis testing and interpretation. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
85390 | Interpretation and report of tests to evaluate fibrinolysis and coagulation | Primary code for the professional interpretation and report of coagulation/fibrinolysis testing. |
85373 | Platelet function testing (e.g., platelet aggregation) | Commonly performed alongside coagulation interpretation when platelet dysfunction is suspected in bleeding patients; technical testing precedes interpretation. |
85730 | Thrombin time | Individual coagulation assay often included in panels that are interpreted under 85390 and may be performed as a technical test prior to professional interpretation. |
85610 | Prothrombin time, international normalized ratio (PT/INR) | Routine coagulation assay frequently used in the clinical evaluation of anticoagulation and included in interpretive reports billed with 85390. |
86003 | Fibrinogen assay | Quantitative fibrinogen testing commonly evaluated and interpreted as part of a fibrinolysis/coagulation interpretation. |