Summary & Overview
CPT 85475: Acidified Blood Test for Hemolysis Evaluation
CPT code 85475 represents an acidified blood test performed in a clinical laboratory to evaluate hemolysis, the breakdown of red blood cells. This laboratory procedure supports diagnosis and monitoring of hemolytic anemias, transfusion reactions, and other conditions that cause red cell destruction. Nationally, accurate coding for this test affects clinical decision-making, laboratory workflow, and payer reimbursement across hospital and outpatient lab settings.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis addresses how these payers handle coverage and coding for laboratory hemolysis evaluation and highlights common billing practices.
Readers will learn the clinical context for CPT code 85475, typical sites of service, and the role the test plays in diagnostic pathways. The publication provides benchmarks for usage where available, notes national policy considerations relevant to laboratory coding, and explains practical documentation elements important for coding accuracy. Data not available in the input will be explicitly noted where applicable.
Billing Code Overview
CPT code 85475 describes a laboratory procedure in which a blood specimen is mixed with acid and evaluated to assess hemolysis, the breakdown of red blood cells. This test is a clinical laboratory service used to identify and quantify hemolytic activity or to help diagnose conditions causing red cell destruction.
Service Type: Clinical laboratory test — hemolysis evaluation
Typical Site of Service: Clinical laboratory or hospital laboratory
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult admitted to the emergency department or inpatient ward with signs of hemolytic anemia: sudden drop in hemoglobin/hematocrit, jaundice, dark urine, elevated lactate dehydrogenase, and unconjugated hyperbilirubinemia. The clinician orders laboratory evaluation for hemolysis, which includes a direct antiglobulin test, peripheral smear, serum haptoglobin, and an acid hemolysis (salt or acid elution) test to evaluate red blood cell fragility and hemolysis. A phlebotomy is performed and the specimen is sent to the clinical laboratory. The medical technologist or laboratory analyst mixes the patient’s blood specimen with an acid reagent and evaluates for hemolysis (breakdown of red blood cells) using visual inspection and spectrophotometric measurement. Results are reported in the laboratory information system and communicated to the ordering clinician for diagnosis and management of hemolytic processes such as autoimmune hemolytic anemia, transfusion reaction, drug-induced hemolysis, or mechanical hemolysis from prosthetic valves. Typical site of service is the hospital laboratory, outpatient hospital laboratory, or commercial clinical laboratory accredited for diagnostic testing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When only the professional interpretation or reporting portion of the test is billed separately from the technical component |