Summary & Overview
CPT 86923: Electronic Crossmatch for Blood Compatibility
CPT code 86923 represents an electronic crossmatch performed by a laboratory analyst who compares patient and donor type-and-screen records in the Laboratory Information System (LIS) to determine blood compatibility. This service supports safe transfusion practices by confirming historic and current immunohematologic data without an immediate physical serologic crossmatch. Nationally, the code matters for hospitals, blood banks, and reference laboratories that rely on LIS-driven workflows to manage transfusion services and maintain patient safety.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the service captured by the code, the typical clinical setting, and which payers commonly cover the service. The publication also provides operational benchmarks, coding context, and recent policy notes relevant to electronic crossmatch workflows and billing. Clinical staff, laboratory managers, and revenue cycle professionals will gain clarity on when CPT code 86923 is used, how it fits into transfusion service processes, and what payer coverage considerations to expect at a national level.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, precise payer-specific reimbursement rates, and related codes.
Billing Code Overview
CPT code 86923 describes a laboratory evaluation commonly called a crossmatch in which the lab analyst assesses compatibility between a potential donor blood unit and a patient by comparing electronic records of patient and donor type and screen using the Laboratory Information System (LIS). This service evaluates immunohematologic compatibility without performing physical mixing or serologic testing at the time of the electronic comparison.
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Service type: Laboratory compatibility evaluation / electronic crossmatch
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Typical site of service: Hospital laboratory, blood bank, or reference laboratory where the Laboratory Information System (LIS) is used to verify donor-patient compatibility
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult hospitalized for acute anemia secondary to gastrointestinal bleeding who may require packed red blood cell (PRBC) transfusion. Prior to transfusion, the transfusion service performs a compatibility check (crossmatch) using the laboratory information system to compare the patient’s type and screen with the donor unit records. The workflow: order entry by the primary team for blood transfusion → collection of EDTA specimen for type and screen if not already on file → blood bank technologist reviews patient ABO/Rh and antibody screen results in the LIS → selects candidate donor unit(s) and performs electronic compatibility check and record comparison → documents the evaluation and releases compatible unit for transfusion. Typical site of service is the hospital blood bank/laboratory; service type is clinical laboratory compatibility evaluation (electronic crossmatch). The patient scenario commonly involves preoperative patients, obstetric patients with hemorrhage, trauma patients, or medical patients with symptomatic anemia where an electronic crossmatch is indicated and no clinically significant antibodies are present.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Standard state — no modifier | Use when no special modifier applies to the laboratory crossmatch service. |
26 |